Taking a Toll

LifeGuide [Hep Talk]

Hep C is surpassing HIV as a deadlier disease
by Larry Buhl

There was a new milestone reached last month when a new study suggested that the number of deaths from chronic hepatitis C now exceed those from HIV-related illnesses. The study was released by the U.S. Centers for Disease Control and Prevention (CDC) on November 8 at the 62nd Annual Meeting of the American Association for the Studies of Liver Diseases (AASLD) in San Francisco.

The data, presented by Scott Holmberg, MD, MPH, chief of the CDC’s Division of Viral Hepatitis Epidemiology and Surveillance Branch, show that 21.8 million deaths overall were reported to the National Center for Health Statistics between 1999 and 2007. The only cases included in the analysis involved reports that specified HIV, AIDS, HCV or hepatitis B virus (HBV) infection as possible contributors to the deaths. The data show that, whereas HCV contributed to roughly 3 per 100,000 deaths in 1999, the HCV-related death rate exceeded 4 per 100,000 people in the United States by 2007.

The data were complied from death certificates, which Dr. Holmberg admitted to being imperfect sources of information because they are often filled in by someone who is not the primary physician. “However, looking at millions of deaths, the trends are clear. In fact, I would argue that this analysis greatly underestimates the relative impact of viral hepatitis,” he said in a prepared statement.

Previous studies have shown that only forty to fifty percent of HCV-infected individuals are identified as such prior to death, whereas eighty to eighty-five percent of patients infected with HIV have been diagnosed before succumbing to their illness, he pointed out.

The numbers also show higher death rates among certain populations. People coinfected with both HBV and HCV faced a thirty-fold increase in the risk of death from liver disease or related complications. Alcohol abuse was associated with a four-fold increase in the risk of death. Coinfection with HIV nearly doubled the risk of death from HBV-related complications and quadrupled the risk of death from HCV-associated liver disease.

Hitting baby boomers hard
Holmberg pointed out that the HCV epidemic is taking a huge toll on those in middle- and late-middle age. Based on the findings, there are now approximately 3.2 million people in the United States living with HCV. Of the total, two thirds were born between 1945 and 1964, meaning only one-third of known HCV cases are under forty-seven.

“This is a population that we are very concerned about, and we really need to be more aggressive in terms of trying to identify who they are and getting them into treatment,” said AASLD president, T. Jake Liang, MD, tenured senior investigator and chief of the liver diseases branch at the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, in Bethesda, Maryland.

There are no data that suggest the so-called baby boom generation has been doing anything unusual to bring about a rise in HCV, as compared to other generations. Rather, the virus, likely present in their bodies for years or decades, is finally taking its toll, researchers say. Chronic liver infection progresses slowly, and most people with HCV do not receive a diagnosis, or even approach their doctors about it, until something is clearly wrong. That makes Holmberg’s findings particularly disturbing, because they suggest an increasing wave of HCV infections to come.

Holmberg’s report did show some good news: a stable rate for HBV-related deaths, a major cause of liver failure and liver cancer. The data also showed a declining incidence of HIV-related deaths, which dropped below the death rate observed for HCV in 2006. Whereas HIV contributed to six per 100,000 deaths in 1999, the rate dropped to less than four per 100,000 deaths in 2007.

What will it take to reverse the rise in HCV deaths? Holmberg’s group gave a clear prescription in their report: “New policy directions and commitment to detect and link infectious persons to care and successful treatment.”

Larry Buhl is a freelance journalist and screenwriter living in Los Angeles.

January 2012