UCLA initiative aims to screen baby boomers for Hepatitis C infection
In response to a recommendation by the U.S. Preventive Services Task Force, UCLA Health has launched an initiative to screen baby boomers for the hepatitis C virus (HCV). Approximately three-fourths of people in the United States living with HCV infection were born between the baby-boom years of 1945 and 1965.
Hepatitis C is a leading contributor to chronic liver disease in the United States; it is the most common cause of cirrhosis, the biggest risk factor for liver cancer and the most common reason for liver transplantation, accounting for more than 30 percent of liver transplants among adults.
HCV infection is even more alarming because, of the estimated 5-million people in the U.S. who are HCV-positive, about three-fourths don’t know it. The infection rarely causes symptoms until the patient has developed chronic liver disease, a process that can take decades.
“This is a major public-health concern,” says UCLA hepatologist Sammy Saab, MD, MPH. “People with hepatitis C don’t wear a badge saying that they’re infected. Most are completely asymptomatic, and the only way they can be diagnosed is through a routine blood test by their healthcare provider.”
The UCLA HCV-screening initiative is an important effort that began with the education of UCLA Health’s primary care leaders on the importance of hepatitis C screening and the national recommendations. A reminder about screenings was then introduced into UCLA’s electronic health record to alert primary-care physicians about patients born between 1945 and 1965 who have not yet been screened
Identifying individuals who are HCVpositive has become all the more important with the advent of antiviral therapy that represents a major improvement over prior treatment.
“Previously, people had to have weekly immune-therapy injections for up to a year, and it was very debilitating — causing headaches, fevers and even depression,” says UCLA infectious-disease specialist Jeffrey D. Klausner, MD, MPH. “Now, we have oral medications that are very well tolerated and far more effective. The vast majority of patients who complete the course — typically three months, but sometimes as short as two months — are cured.”
Baby boomers are a particularly important group to screen because many from that age group who are infected have had the virus for a long period of time, putting them at high risk for developing the complications of liver cirrhosis, liver cancer and liver failure, Dr. Saab notes. “We have new treatments that are safe, rarely cause side effects and can cure patients,” he says. “If we wait until they become symptomatic, it’s often too late to treat hepatitis C.”
Patients who test negative do not need to be tested again, assuming they don’t meet any of the other high-risk criteria: having ever injected drugs or used intranasal cocaine, having been on hemodialysis or having received transfusions or an organ transplant before 1992.
When a patient tests positive, the ordering physician receives a notification, along with recommendations for additional tests to confirm the infection and assess the degree of liver damage. A hepatitis C treatment coordinator monitors the laboratory results and provides assistance to link the providers with UCLA hepatologists and infectiousdisease specialists so that patients can receive timely and appropriate care.
“Hepatitis C is a major cause of liver disease, and now we can prevent these complications through early treatment,” Dr. Saab says. “The biggest barrier to curing hepatitis C is not knowing who is infected. That’s why this initiative is so critical.”
Find out more about Hepatitis C screening at uclahealth.org/infectiousdiseases.