July 10, 2013

The threat of a new epidemic

by John Coulter | Coulter is vice president, Molecular Diagnostics, at Abbott.

Tuesday, July 9, 2013

A public health problem decades in the making, hepatitis C (HCV) has become a leading viral killer in the U.S., slyly growing in prevalence under the radar of both patients and the American public.

A disease that once may have been scarcely thought of, HCV is now commonplace and costs the U.S. more than 15,000 lives and nearly $11 billion each year. In recent years, government agencies such as the Centers for Disease Control and Prevention and nonprofit groups have been working overtime to alert the public through events such as World Hepatitis Day, which is held annually on July 28.

In Roanoke, the New River Valley and throughout Southwest Virginia, demographic trends reflecting an aging population put residents of the state at risk. With as many as one in 30 U.S. baby boomers (adults born 1945-1965) infected with HCV and at least 800,000 of these unaware they’ve contracted the virus, it’s no surprise the CDC now recommends HCV screening for baby boomers.

More recently, the U.S. Preventive Services Task Force recommended all baby boomers get tested for HCV, sending a clear signal to health care professionals, policy makers and the public that screening for HCV is beneficial for both patients and the public health.

Increasingly, conversations about a variety of medical concerns — cancer, diabetes and mental health, for example — are driven by deeper understandings of the genetic structures of illnesses.

Less frequently talked about among stories of amazing science and revolutionary care, however, is how molecular testing is helping the U.S. face one of its biggest infectious disease challenges.

As our nation battles a burgeoning HCV epidemic, it’s important to recognize the everyday significance molecular testing plays in battling this long-silent killer. Molecular testing enables a more clearly mapped battleground on an individualized basis, and that’s just a part of how diagnostics is reshaping the health community’s approach to HCV.

Health experts fighting HCV have identified six major genetic variations, or genotypes, and more than 50 subtypes of HCV.

The genetic spectrum of HCV is as diverse as the boomer generation itself, but make no mistake about it, anyone of any age, race or gender can contract any genotype or subtype of HCV. With the same DNA sequencing principles used to determine hereditary predisposition for some types of cancers, companies like mine have pioneered systems that provide physicians with HCV genotype identification for each patient.

This information is vital in determining how to treat each patient individually, since each genotype of the virus responds to treatment differently. A recent article in the New England Journal of Medicine illuminated this fact by mapping genotype-specific responses to current and developing therapies. Armed with genotyping data for each patient, doctors can prescribe the treatment that is most likely to be successful and help avoid side effects from less targeted, less effective treatments.

From the early 1990s, when we introduced a pioneering assay to protect our nation’s blood supply from hepatitis, to today’s technology that helps identify genotypes faster, diagnostics have helped offset the global HCV burden and create early warning systems for both patients and doctors. Getting tested for HCV is critical for adults, especially those who fall within the CDC’s recommended guidelines.

However, the journey to wellness in battling HCV goes beyond just getting tested. Our ability to understand the genetic makeup of the virus — thanks to advanced diagnostics — and to respond with appropriate treatment options brings new empowerment to the fight against the HCV epidemic. Molecular diagnostics allow us to zoom in on HCV and, in doing so, make this public health challenge an increasingly personal one.

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