Advice not to test boomers for hep C creates backlash
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 bloodborne 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 Cendemic 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.
Experimentation with injection drugs and potentially unsafe sex among this age group during their teenaged and young adult lives could also have ratcheted up the spread of the virus.
An estimated 250,000 to 300,000 Canadians are infected with hepatitis C, and studies suggest 45 to 70 per cent — about two-thirds of them baby boomers — have no idea they carry the virus.
“Hepatitis C is like having a ticking time bomb in your liver,” says Michael Houghton, a researcher at the University of Alberta who first identified hepatitis C with co-investigators while working in the U.S. and then developed a blood test for the virus.
However, a new generation of antiviral drugs can wipe out the infection in more than 95 per cent of cases — providing hope that treatment could fulfil the World Health Organization’s goal of eliminating the disease by 2030. Globally, 130 million to 150 million people have chronic hepatitis C infection and up to 500,000 die each year from the disease.
“HIV we cannot cure. Hepatitis B we cannot cure. Human papillomavirus we cannot cure,” says Houghton, who is working on a preventive vaccine. “With hep C, it’s the first example of a human persistent virus that we can not just ameliorate but we can actually eradicate.
“So we’ve got this fantastic opportunity. And are we taking advantage of it? No, we’re just dragging our heels,” he says.
The CTFPHC working group that developed the guidelines says two systematic reviews of the medical literature found no evidence of benefit from widespread population screening for hepatitis C among low-risk adults, which they maintain covers most baby boomers.
“To our knowledge there’s no good studies published at this time to show that baby boomers in Canada have an especially high prevalence of the virus,” says Dr. Roland Grad of McGill University in Montreal, who chaired the 12member working group comprised mostly of family doctors.
A key reason for promoting only risk-based testing is cost: the newer antiviral medications initially carried price tags of $45,000 to $100,000 for a treatment course of many weeks. The guideline authors estimate that widespread testing and treatment would set the healthcare system back by about $1.5 billion.
“Are we going to suggest that $1.5 billion of publicly funded taxpayer money should be spent on this issue (when we) found no direct scientific evidence to support it?” says Grad.
“We were concerned that if we recommended for it in the absence of direct evidence, it could be causing more harm than good because we simply don’t know if screening is beneficial,” he says, explaining the high cost of the drugs could mean many people diagnosed with the virus would not be able to afford treatment.