Critics push back against hepatitis C screening advice, say boomers should be tested
TORONTO — When Walter Buchanan learned his brother-inlaw needed a liver transplant because of advanced cirrhosis caused by a long-undiagnosed infection with hepatitis C, he offered to donate part of his organ to save his life.
But Buchanan was shocked when doctors told him he couldn’t be a donor — tests revealed that he, too, carried the virus and that his liver was severely scarred, even though he’d experienced no symptoms.
“When they told me, my mind just went deep-six,” he says from his home in Queensville, Ont, just north of Toronto. “And my first question was: ‘OK, how long do I have?’
“That’s what scares people the most about hep C, because people think ‘Oh my God, it’s a death sentence.”’
Hepatitis C can indeed kill. Over time, the virus causes cirrhosis, which can lead to liver failure. About 10 per cent of those with advanced cirrhosis go on to develop liver cancer. But damage from hepatitis C can take decades to manifest and cause noticeable symptoms; many people have no idea they harbour the virus — hence its moniker as a “silent killer.”
At 67, Buchanan is part of the baby boomer generation, the group that makes up roughly a quarter of Canada’s population. Liver specialists contend people born between 1945 and 1965 are at the greatest risk of having been unknowingly infected by the blood-borne virus, which wasn’t even identified until 1989.
Yet recently released hepatitis C screening guidelines from the Canadian Task Force on Preventive Health Care (CTFPHC) recommend against routine testing of baby boomers — or adults of any age — unless an individual has one or more risk factors, including a history of IV drug use; travel to or immigration from hepatitis C-endemic countries; or a blood transfusion or organ transplant before 1992, when donations weren’t tested for the virus.
That recommendation has dismayed many hepatologists (liver doctors), infectious disease physicians and researchers who have long preached that all boomers should be tested for the virus, in part because they grew up at a time when doctors and dentists gave vaccinations and freezing with reusable and often inadequately sterilized needles.
Toronto hepatologist Dr. Jordan Feld says recent negotiations between the drug makers and the Pan-Canadian Pharmaceutical Alliance (PCPA) — representing the federal, provincial and territorial governments — have substantially reduced the cost of several of the hep C medications under publicly funded drug plans.
While results of those negotiations are confidential, it’s believed their price tags could now be as low as $10,000 to $20,000 per patient.
Currently, patients with a certain level of liver damage or who fit other criteria, such a co-infection with HIV or hepatitis B, have their medications covered by some provincial drug plans. But in February, both B.C. and Ontario announced they will expand coverage next year to all infected residents, regardless of disease severity.
Feld, director of research at the University Health Network’s liver clinic, says even without access to treatment, those who find out they’re infected can avoid transmitting the virus to others and make liver-protecting lifestyle changes such as avoiding alcohol and losing weight.
That was the case for Marsha Lecour, who was diagnosed with hepatitis C in the mid-1980s after tests showed her liver was abnormal.
“I’ve been vegetarian since 1972, so that stood me in good stead,” says Lecour, a retired Toronto teacher who turns 65 in June. “So being vegetarian and not drinking alcohol were two factors that really were in my favour.”
Still, she did develop advanced cirrhosis over the next 10 years and was treated more than once with drug combinations that included interferon, a protocol since replaced by the newer antivirals. After completing a 48-week triple-drug therapy, she was declared virus-free and her liver has since recovered significantly.
“I think all baby boomers should be tested, regardless of risk factors, because you just don’t know,” says Lecour, whose only known risk factor was a blood transfusion during heart surgery at age four. “For this age cohort, the longer we wait and if we have hep C, the more damage develops over time and the harder it is possibly to treat.”