Hep C testing unnecessary for most

Dear Doctor : My doctor recommends that I be tested for hepatitis C, and I've also seen commercials urging people to get tested for the virus - but I have no risk factors. Is it really necessary to get tested for it?

Dear Reader : The majority of people who become acutely infected with hepatitis C will not have any symptoms. Of people who acquire the infection, 15 percent to 45 percent will clear it on their own; that is, their immune system will ward off the virus. However, anywhere from 55 percent to 85 percent of patients will develop a chronic infection and a chronic inflammation of the liver. Many of them won't have symptoms until the chronic infection leads to cirrhosis of the liver. That development can occur more than 20 years after the onset of infection.

New cases of hepatitis C are rare, with only 0.3 per 100,000 individuals, and are largely caused by injecting drugs via a needle used by someone with the virus. This practice was most common in the 1960s, '70s and '80s, and those at most risk were born between 1945 and 1965.

Based on this data, a 2012 Morbidity and Mortality Weekly Report (MMWR) from the Centers for Disease Control and Prevention recommended a one-time testing for hepatitis C for those born in the United States between 1945 and 1965, saying that it would reduce death rates and liver cancer rates from the disease.

In years past, treatment of hepatitis C consisted of interferon-based therapy. This type of therapy was poorly tolerated by patients, with horrible side effects from the drug, and it cured patients only 45 percent of the time. New antiviral therapies for hepatitis C do not contain interferon and are well-tolerated. They are simple to take, with once-a-day dosing for 12 weeks and cure rates of 90 to 100 percent.

But the cost of the treatment is exorbitant. One 12-week course costs $94,500; another course of treatment costs $84,000. Due to the costs, insurers will not cover these medications unless there is some form of liver inflammation.

Now think about the population of people born between 1945 and 1965. These patients are between 52 and 72, and many of those at high risk have already seen a doctor and had multiple liver tests. The likelihood of them being newly diagnosed with hepatitis C is low, and the likelihood that the infection will lead to cirrhosis or liver cancer if liver enzymes have been persistently normal is similarly low. By screening people who have little risk of the complications of hepatitis C, we will be diagnosing more people without allowing them to get treatment.

Because of that, the focus on hepatitis C screening should be on those with high risk of infection and a high likelihood of transmitting hepatitis C to others. With injection drug use increasing in this country, this population needs to be actively screened.

If you've been seeing a doctor regularly, have had no previous risk factors and are not at a high risk of new infection, there may be no need to be screened for hepatitis C.

Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles.

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