This summer, the Tennessee Department of Health (TDH) issued a public health advisory in the wake of a nationwide increase in the rate of Hepatitis C infection. The alert called for Tennesseans to learn more about the life-threatening disease and to consider being tested for chronic Hep C infection.
A Centers for Disease Control and Prevention report issued in May showed Hepatitis C as the most common blood-borne infection in the United States with approximately 3 million people living with Hep C. While the increase in disease is nationwide, the largest increases have been in the Appalachian region. The rate of acute Hepatitis C cases in Tennessee has more than tripled in the last seven years.
When announcing the public health advisory, TDH Commissioner John Dreyzehner, MD, MPH, said, “In addition to reported cases of acute Hepatitis C, it is estimated that more than 100,000 Tennesseans may be living with chronic Hepatitis C and not know it.”
Tim Jones, MD, who has served as the state epidemiologist since 2007, noted, “The state of Tennessee is number four in the country for the amount of Hepatitis C that we see. We have three times the national average of rates of disease.” Looking at the map of Tennessee, Jones said there are a particularly high number of cases along the eastern border and northeastern part of the state.
The good news, Jones added, is that along with increased rates of disease are improved treatment options. “One of the reasons it’s getting more attention now is that there are better treatments available, and they are relatively new to the market.”
In the past, he continued, the treatment regimen was difficult, not terribly effective and included a lot of side effects for many individuals. “Now there are much more rapid and effective treatments so there is more enthusiasm for getting people tested and into treatment,” said Jones, who has been with the TDH for 18 years and previously worked for the CDC. “You can now treat it in 12 weeks … and these drugs cure it.”
However, he continued, the problem is the cost of the three-month regimen, with a price tag coming in at $60,000-$90,000. He added it’s an issue public health officials, providers and insurers are all struggling to address. Time, he continued, could provide at least a partial solution. “It’s likely as more medications come on the market, and there are several in the pipeline, those costs will be driven down.”
And, Jones pointed out, the slow progression of the disease gives those infected time to get into appropriate care. “About 20 percent of people will get rid of it on their own. For the other 80 percent, the disease progresses very slowly. If people catch it early, it can take 20-30 years before getting to the end stages,” he said.
Although price is an issue, another consideration is the cost not to treat. “As (Hepatitis C) progresses, it can lead to fibrosis of your liver up to liver failure. It’s the number one cause for liver transplants,” Jones noted. He added, Hep C is also the main cause for cirrhosis of the liver. If the disease progresses to one of these conditions, the price of caring for individuals with Hep C could far outstrip the cost of the drugs to cure it.
A blood-borne pathogen, Jones said the nation’s blood supply up until the late ‘80s/early ‘90s helped spread the disease. Today, however, the biggest risk factor is IV drug use.
“There are pretty negative connotations when a disease is associated with IV drug use, but even one indiscretion decades ago can lead to these problems years later,” he pointed out.
Ideally, Jones said the following people should be tested:
- All baby boomers (anyone born 1945-1965),
- Anyone who has ever injected drugs (even once),
- Anyone who received a blood transfusion or organ transplant before 1992,
- Any healthcare worker who might have had a needle stick injury,
- Anyone who has gotten an illegal tattoo or unsanitary piercing (from an unlicensed provider),
- Anyone with HIV or AIDS,
- Those with abnormal liver tests or other liver disease, and
- Anyone on dialysis.
While healthcare providers might be able to rule out some of the risk factors for their patients, Jones said the only way to really determine if an individual should be tested is to broach the topic and ask questions.
Of course, he continued, the best defense is a good offense … namely prevention. With no vaccine for the disease, efforts to avoid exposure are the best weapon in stopping the spread of Hep C. Don’t share needles is the key message, and that includes the ‘diabetes curious’ … the person who wants to see what their blood sugar is so they try out a diabetic friend’s testing equipment.
“Don’t share needles … period,” Jones stated firmly.
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