New guidelines recommend hepatitis C screening for those born between 1945 and 1975

Canadians born between 1945 and 1975should be tested for the potentially liver-destroying virus hepatitis C, a new set of guidelines recommends.

More than 250,000 Canadians are believed to be infected with hepatitis C, but an estimated 40 to 70 per cent are unaware they harbour the blood-borne virus because it can take decades before symptoms become evident. Chronic infection can lead to cirrhosis of the liver or liver cancer.

The Canadian Association forthe Study of the Liver, a national group of health-care providers and researchers, published its guidelines on testing and treating hepatitis C in Monday's edition of the CMAJ.

A key recommendation is that people be tested based on their age not only possible risk factors, said Dr. Jordan Feld, a liver specialist at Toronto's University Health Network and a co-author of the guidelines.

"And the reason we've done this is it just happens that somewhere between two-thirds and three-quarters of people with hepatitis C were born between 1945 and 1975 in Canada," he said.

"So just the way someone gets a blood pressure check or a cholesterol check or a colonoscopy based on their age, we would recommend that they get a hepatitis C test if they're born between those years.

"And if we do that, we hopefully diagnose the vast majority of people living with hepatitis C."

People at high risk

The recommendations differ from those issued last year by the Canadian Task Force on Preventive Health Care in the same journal.

"We recommended against screening the average Canadian who's not at elevated risk for this chronicinfection,"said Dr. Roland Grad,a member of the Canadian Task Force for PreventiveHealth Care and a family doctor in Montreal.

Grad'sreasons included:

• Absence of direct evidence on the benefitsof screening.
• The costs of screening and treatment wouldhave a dramatic impact on health-care budgets inthe order of $1.5 billionin 2016dollars.
• Aconcern that many individuals would be identified by screening as chronic infectionwould not get timely access to treatment.

"We really do not know whether these drugs are a cure," Grad said, given the trials lasted a few years andit typically takes 20 to 30 years for the virus to cause damage.

People at high risk include those who:

• Engaged in IV drug use with shared needles.
• Had a tattoo or body piercing with unsterile equipment.
• Had unprotected sex with multiple partners.
• Received a blood transfusion, blood product or organ transplant prior to 1992.

Feld said almost all private and most provincial and territorial drug plans now cover thecost of the drugs.

• Hepatitis C could be eliminated in Canada, but drug prices, screening barriers stand in the way
• Broad Hepatitis C screening of Canadian adults not supported by evidence, task force concludes

Screening and treating patients

Screening for the hepatitis C virus, or HCV, involves an inexpensive blood test. Most people exposed to the virus are able to clear the infection.

"As the landscape has evolved such thateveryone can access therapy we felt much more strongly that then everyone who is at risk should be tested," said Feld'sco-lead author, Dr.Hemant Shah, a liverspecialist and clinical practice director of the Francis Family Liver Clinic at Toronto's University Health Network.

JoeCamaralearned he contracted hepatitis C in 1993 after using intravenous drugs. The Toronto man was sent to the U.S. for treatment.

"I was throwing up. I would turn all yellow. Just sick," he recalled. SinceCamarastarted receiving direct-acting antiviral medication, he says his energy has returned and he feels great.

Eliminate viral hepatitis C by 2030

BernadetteLettner,a registered nurse at the Regent ParkCommunity Health Centre inToronto, where Camara is now treated, points out that Canada has signed on to the WHO commitment to eliminate viral hepatitis C by 2030.

"I think that if you commit to doing something like that, then you're going to have to make sure you're able to test people who previously wouldn't know that they're hep C positive," she said.

According to Lettner, many of those who are unaware are baby boomers. "The majority of new cases are in people who inject drugs or in prison populations," she said.

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Those with a chronic infection based on two positive blood tests six months apart are eligible for the oral treatments, Lettner said.

Shah acknowledged the liver specialists all have relationships with the manufacturers of different hepatitis C drugsbut said it didn't influence their recommendations.