The Institute of Medicine, a branch of the US National Academy of Sciences, is urging healthcare providers to take steps to battle liver-damaging hepatitis B and C, which are often overlooked viruses. Surprisingly, hepatitis B and C together infect three to five times more Americans than the AIDS virus does. In the next 10 years, these two liver-damaging infections will kill about 150,000 people in the US alone, says a new Institute of Medicine report.
The Institute is calling for a major public health push to decrease the stigma of these simmering viruses, which are to blame for nearly half the liver transplants performed every year. Some people can fight off hepatitis B or C, but it becomes a chronic, incurable infection in anywhere from 3.5 million to 5.3 million Americans, the report estimates. While anyone can be infected, the viruses disproportionately affect blacks, Asians and Pacific Islanders.
Among the report’s recommendations is the wider use of a vaccine for hepatitis B, improved public awareness and improved health services for hepatitis patients, and greater testing of the at-risk population. People at highest risk for hepatitis B include those born in parts of Asia and Africa where the virus is particularly widespread, infants born to infected mothers, sexual partners of the infected, and injecting drug users. At-risk adults can seek vaccination. Those at highest risk for hepatitis C include current or former injecting drug users and people who received a blood transfusion before 1992.
“There is a push in the report to put the information out there to those who need it the most. Perhaps at the doctor’s offices, homeless shelters, health clinics and maybe in places where needle exchanges are performed. Maybe that’s the place to screen and identify the problem and get the information out,” said Dr. Patricia Turner, an assistant professor of surgery at the University of Maryland School of Medicine.
According to Larry Siebert, CEO of Chembio Diagnostics, rapid point-of-care testing may be key in enabling physicians’ access to a patient’s status. It may also provide the ability to begin treatment immediately—
“Part of the challenge of treating those at risk for hepatitis is compliance on both ends: screening and treatment. It can prove to be a challenge to have patients come back for a follow-up visit to get the diagnosis of an exam. During this waiting period, a patient can be transmitting the virus to one or multiple partners or sharing a needle, thus contributing to the growing hep C problem,” says Siebert. “Individuals in high-risk groups should be diagnosed at the point of care so as to provide the best chance for starting treatment as early as possible.”
At present, the only hepatitis treatment approved by the US Food and Drug Administration is a cocktail of interferon and ribavirin, which is toxic, must be administered in a 48-week course and is effective in less than half of patients. Siebert went on to note that rapid, point-of-care tests such as those his company is developing for hepatitis C may prove to be an essential and integral part of any testing for up-and-coming more patient-friendly therapies. These include Vertex’s protease inhibitor telaprevir for hepatitis C, currently in Phase III; Merck's hepatitis C drug candidate boceprevir; and Roche’s PEGASYS, which works to reduce the amount of virus in the blood to help the body fight the virus. “With fewer side effects, patients will be more likely to agree to be screened early and to comply better with treatment,” says Siebert.
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