Deaths attributed to hepatitis in the U.S. rose during the past decade to surpass those from HIV, posing a future public health burden as most people aren’t aware they are infected.
The baby boom generation, those born from 1946 to 1964, are the most at risk to the bloodborne virus, said John Ward, director of the Centers for Disease Control and Prevention’s hepatitis division, and an author of the study.
“Injection drug use was frequent in this age group, and even one-time exposure to injection drug use carries a high risk,” Ward said in an interview. “Seventy-five percent of the mortality is in this age group, and that mortality is increasing. That’s the sobering facts for the baby boom generation.”
Hepatitis is a viral infection that can cause swelling and inflammation of the liver and can lead to damage of the organ, cancer and death, according to the National Institutes of Health. The virus has different forms -- A, B and C -- which are further broken down into subgroups called genotypes.
Researchers studied 22 million death records from 1999 to 2007, finding 15,000 died from hepatitis C alone, compared with 13,000 from HIV. As many as 1.4 million people are living with chronic hepatitis B, according to the study, and 3.2 million have hepatitis C, with two-thirds born from 1946 to 1964. The results were reported today in the Annals of Internal Medicine.
‘So Little Attention’
“Few diseases of such morbidity and mortality in the United States have received so little public attention and funding as chronic viral hepatitis,” the researchers wrote in the study.
A vaccine for hepatitis B was first approved by the U.S. Food and Drug Administration in 1981, and has been recommended for all infants since the early 1990s, Ward said, eliminating its prevalence among younger generations. Hepatitis C wasn’t discovered until 1989 and has no vaccine, he said.
“It’s an infection that doesn’t always cause you to become ill when you become infected,” Ward said. “It progresses silently over decades, and many people do not become symptomatic or sick until their liver damage is quite advanced, or they develop liver cancer, and so for those reasons, the scope of the problem is underappreciated.”
As many as 170 million people worldwide are chronically infected with the hepatitis C virus, according to the World Health Organization.
While the number of people infected with HIV rose to 34 million globally in 2009, the virus that leads to AIDS, once a death sentence, can be reduced to low levels in the blood with use of combination antiviral medicines. About 1.2 million Americans have HIV, with about 43,000 new cases reported in 2008, according to the CDC.
The standard treatment for hepatitis C for the past decade has been a combination of the antiviral drug ribavirin with interferon, an immune-boosting protein sold by Merck & Co. as PegIntron and by Roche Holding AG as Pegasys. Patients receive weekly shots of Interferon for as long as a year, which can cause side effects such as fatigue and flu-like symptoms.
A new class of drugs were introduced last year called protease inhibitors, including Victrelis from Whitehouse Station, New Jersey-based Merck and Incivek by Vertex Pharmaceuticals Inc. of Cambridge, Massachusetts. These medicines attack the virus itself, and have been shown to cure more patients in less time with fewer side effects, although they still must be combined with Interferon shots.
A further breakthrough in treatment may come this year with the development of the experimental drug class called nucleotide polymerase inhibitors, which bind to a different part of the virus than the protease inhibitors. These drugs are pan-genotypic -- meaning they are effective across the different types of hepatitis C. They could become the backbone for an Interferon-free combination.
Abbott Laboratories, Bristol-Myers Squibb Co., Gilead Sciences Inc., Johnson & Johnson, Merck and Vertex are among the drugmakers acquiring and developing these new therapies as they seek a potential combination that may lead to a cocktail pill to control the disease, similar to the approach taken with HIV drugs.