Baby Boomers Facing Hepatitis Time Bomb
By Mark G Swain, MD, MSc, FRCPC
Professor of Medicine and Cal Wenzel Family Foundation Chair in Hepatology
Snyder Institute for Chronic Diseases
Head, Division of Gastroenterology, University of Calgary
Hepatitis C is a virus which was first identified in 1989. Very quickly it came to be appreciated that hepatitis C was a significant health issue, infecting roughly 250,000 Canadians; a five-fold higher number than are infected with HIV. Hepatitis C is mainly acquired through exposure to contaminated blood; through transfusions and through the use of intravenous drugs. In fact, after exposure to hepatitis C, even after one exposure, up to 85 per cent of people will keep the virus in their bodies for the rest of their lives. Hepatitis C lives in the liver where it multiplies, and as part of its’ life cycle, hepatitis C kills liver cells. In response to these dying liver cells the liver tries to heal itself with scar tissue, and in roughly 20 per cent of infected people after 2-3 decades of infection, the amount of scar tissue in the liver can get to the point where these individuals have developed cirrhosis of the liver. Many people believe that excessive alcohol intake is the cause of liver cirrhosis; however, there are in fact many causes of cirrhosis, with hepatitis C being an important cause of cirrhosis in Canada.
Typically people infected with hepatitis C have no symptoms, and so they do not suspect that they are infected. Over time they often forget that they have a risk factor for hepatitis C acquisition, and it is not until 20 or 30 years later that they are discovered to have hepatitis C infection, and in many instances have advanced liver scarring. This issue has been recently brought to light by the findings, in a large American study, of a significant increase in the incidence of hepatitis C infection amongst baby boomers (prevalence rate of 3 per cent of people within this age group). This finding in general reflects lifestyle choices made by individuals who lived during the 1960’s and 70’s, when experimentation with injection drugs occurred widely. Often this experimentation took the form of a single exposure, and was soon forgotten. However, it is becoming increasingly apparent that hepatitis C was acting in a stealth fashion, silently destroying the livers of many of these people. As a result of this, hepatitis C has now overtaken AIDS as a cause of death. Hepatitis C is currently the most common indication for liver transplantation in Canada; however, as a result of organ shortages up to 20 per cent of people with hepatitis C-related liver failure will die waiting for a liver transplant. In addition, hepatitis C-related cirrhosis leads to the development of liver cancer in up to 3 per cent of infected people per year.
Despite these concerning statistics, not all is doom and gloom for these baby boomers. Treatments for hepatitis C have made astounding breakthroughs through research over the past few years. Specifically, just recently Health Canada has approved 2 new therapies which, when combined with standard treatment protocols, can cure hepatitis C in up to 75 per cent of people infected with the most common type of hepatitis C in Canada. Unfortunately, these new therapies are very expensive, potentially limiting access to those infected and in need of treatment most. In Calgary we are fortunate to have a world leading Hepatitis Unit, located in the Snyder Institute of Chronic Disease at the University of Calgary, which has specialized expertise in the treatment of hepatitis C and its’ complications, providing those infected with leading edge hepatitis C care.
This column was written in response to a study from the US Centers for Disease Control and Prevention (CDC), published in the February 21 2012 issue of the Annals of Internal Medicine.
The research paper can be found here: http://www.annals.org/content/156/4/271.abstract