Real World Health Care

This Sunday, July 28, is World Hepatitis Day, an observance that reminds us that hepatitis (inflammation of the liver) remains largely unknown as a major health threat. Approximately half a billion people worldwide and 4.4 million people in the U.S. live with chronic viral hepatitis, with one million deaths resulting from the disease each year.

Linda Barlow

The goal of World Hepatitis Day is to move from awareness to action to address the “silent epidemic” of viral hepatitis – so named because most people don’t experience symptoms when they first become infected, often not until they develop chronic liver disease many years later.

Stakeholders in government and private industry are stepping up to answer the call, supporting early detection and medical intervention as key starting points to effectively address the epidemic.

Earlier this month, Quest Diagnostics announced a partnership with the CDC to improve public health analysis of hepatitis C screening, diagnosis and treatment for the 3.2 million Americans living with it. Under the collaboration, anonymous patient data will be evaluated to identify and track epidemiological trends in hepatitis C virus infection, testing and treatment and determine how those trends differ based on gender, age, geography and clinical management.

“Our collaboration with the CDC underscores the importance of using diagnostic information to derive useful insights enabling effective prevention, detection and management programs for diseases with significant impact on public health,” Jay Wohlgemuth, M.D., senior vice president, science and innovation, Quest Diagnostics, said in a statement.

Early detection was also the focus of a 2012 National Institutes of Health (NIH) study published in Proceedings of the National Academy of Sciences. In the study, researchers concluded that elevated blood levels of a specific enzyme and a specific protein early on in the course of hepatitis C infection were much more likely to develop into advanced fibrosis or cirrhosis. The study found:

• The long-term course of chronic hepatitis C is determined early in infection.
• Rapidly progressive disease correlated with persistent and significant elevations of alanine aminotransferase (ALT), an enzyme released when the liver is damaged or diseased.
• Rapidly progressive disease correlated with persistent and significant elevations of the protein MCP-1 (CCL-2), a chemokine that is critical to the induction of progressive fibrogenesis and ultimately cirrhosis.

Armed with this information, clinicians are expected to make a fairly accurate assessment of which patients are likely to develop advanced disease rapidly. Instead of waiting for a new class of drugs to be approved, these patients are likely to be pressed to start treatment right away – with the goal of treating the virus before it causes cirrhosis of the liver.

Because hepatitis does not result in symptoms until serious liver damage occurs, getting tested is also crucial. In fact, the CDC recommends that everyone born from 1945-65 get a one-time test for hepatitis C because they are five times more likely than American adults in other age categories to be infected and face an increased risk of dying from hepatitis C-related illnesses.

The first FDA-approved hepatitis C genotype test is now available in the U.S. From Abbott, the fully automated Realtime HCV Genotype II test determines the specific type or strain of the HVC virus present in the blood of an HCV-infected individual.

Early awareness and prevention-based practices are crucial to avoiding hepatitis. But what else can be done to ensure access to and availability of reliable and cost-effective screening and diagnostics, in addition to safe and simple treatment regimens for people with the disease?