A reader asked, "What is the significance of a positive blood test for hepatitis C in an asymptomatic adult?"
Hepatitis C (HCV), a virus that attacks the liver, is widespread, dangerous, underdiagnosed and very expensive to treat.
HCV is usually asymptomatic when first acquired. Over a 20- to 30-year period, the virus slowly and relentlessly attacks the liver in the majority of persons infected. Symptoms occur as progressive scarring, or cirrhosis, of the liver develops. Cirrhosis leads to fatigue, jaundice, swelling of the abdomen and risks of severe bleeding. HCV may cause liver cancer.
Liver transplantation may offer the only option for treatment when the disease is advanced.
Worldwide, an estimated 175 million people are infected with HCV. Three million Americans are affected.
Vaccines are available for protection against Hepatitis A (HAV), which is acquired from contaminated food and water, and Hepatitis B (HBV), which is acquired from blood and other bodily fluids. HBV may also lead to liver cancer. Guidelines are in place for the appropriate use of these vaccines.
HCV is acquired from blood and blood products. Tests are available to measure both the C virus and antibodies in human blood. Despite intensive research, however, no vaccine has yet been developed to protect against HCV infection.
A test to screen donated blood for HCV has been used in the United States since 1992. Transfusion before that year carries an uncertain risk for the disease. A one-time screening blood test for HCV is currently recommended for all Americans born between 1945 and 1965.
HCV may be transmitted from mother to fetus, through shared needles in illicit drug injections and from contaminated instruments used in tattoos and body piercings. There is a small risk of transmission via sexual intercourse. Health care workers and emergency responders are at risk, emphasizing the need for universal precautions for contact with any bodily fluids.
Most cases of HCV infection come to light when abnormalities are noted in blood work related to liver function. More-detailed laboratory study is then employed to assess the stage of the illness. A liver biopsy may be taken even deeper examination on the stage or severity of the disease.
No therapy may be needed for mild HCV infection. Close monitoring of liver function is essential. Anyone with HCV disease at any stage should avoid alcohol.
If studies indicate progressive liver disease due to HCV, a combination of medications can be used to rid the body of the virus. Therapy may, however, be associated with complex side-effects.
A new drug to treat HCV, Sovaldi, was recently approved by the Food and Drug Administration. Sovaldi must be taken with other anti-viral medication. A recommended three-month course of Sovaldi will cost an American patient approximately $85,000. The manufacturer has licensed drug companies in India to produce the drug much more cheaply for the Asian market. Debate continues about the cost and the effectiveness of Sovaldi.
The new drug raises a number of questions: How much did the drug cost to develop and to market? Should Americans bear the full cost for research and development? How much profit should a drug company realize from a new product? Should every insurance plan be required to cover every new drug that the FDA approves?
These questions apply to a number of new drugs for treating a variety of diseases in addition to HCV. We cannot dodge the challenge to formulate policy for appropriate pricing and use of new therapies.
Contact Clif Cleaveland at firstname.lastname@example.org.