Hepatitis C Biology Basics
Hepatitis C is the most common blood-borne virus, according to the U.S. Centers for Disease Control and Prevention (CDC). More than 3.2 million Americans are known to be infected with the hepatitis C virus and approximately 17,000 more become infected each year. More than 12,000 people die every year from hepatitis C-related liver diseases. The virus may be dormant for a long time, so some people may have it and not know until they have liver damage, liver cancer or liver failure. Baby boomers, born between 1945 and 1965, are the largest population and most likely to have the disease and not know it.
Hepatitis C transmission was most common in the 1970s and 1980s, before widespread blood screening practices and blood safety standards were adopted in 1992. Anyone who received blood, blood products, or organ transplants before 1992 is also at higher risk for having hepatitis C. Currently, hepatitis C is largely transmitted through injection drug use and sharing needles with others who are infected.
It is less likely for someone to contract hepatitis C through sexual contact, although not impossible. Some populations are at higher risk, including people who already have a sexually transmitted disease, having multiple partners, and among men who have sex with men who are HIV-positive.
Someone with hepatitis C can have an acute or chronic version of the disease. The acute version may include a mild illness that occurs a short time after someone is exposed to the virus. Chronic versions include a long-term illness such as liver damage, cirrhosis, liver failure or liver cancer. Other symptoms of either version include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, gray-colored stools, joint pain and jaundice.
Video courtesy of Gilead Sciences
Screening and Treatments
Blood tests are used to screen for hepatitis C antibodies, which are released into the bloodstream if someone has or has had exposure to hepatitis C. If the test is positive, additional tests are needed to determine if the infection has been cleared or is a chronic infection.
Current treatments for hepatitis C include a variety of antiviral medications. It is possible for someone to be treated for the virus and be “cured” or “cleared.” However, not everyone will respond successfully to treatment depending on the exact type of hepatitis C that they carry. New treatments have a cure rate of over 90 percent, depending on the specific type of hepatitis C.
The CDC recommends the following population groups for hepatitis C screening:
Experts at the American Association for the Study for Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) have updated www.HCVguidelines.org, a website developed in collaboration with the International Antiviral Society-USA (IAS-USA) to provide up-to-date guidance on the treatment of hepatitis C virus (HCV). Based on expanded “real-world” experience with the tolerability and efficacy of newer HCV medications, the section on “When and in Whom to Initiate HCV Therapy” no longer includes tables that offer recommendations on how to prioritize patients for treatment. - See more at: http://www.idsociety.org/HCV_Therapy_Update/#sthash.HJ1LeNrL.dpuf
- People who currently inject drugs.
- People who injected drugs in the past, even if it was just once or a long time ago.
- People who are HIV-positive.
- People who have abnormal liver tests or liver disease.
- People who received donated blood or organs before 1992.
- People who are exposed to blood on the job through a needlestick or injury with a sharp object.
- People who are on hemodialysis.
Hepatitis C-Related State Laws as of Jan. 1, 2015
|CA SB 870 Chapter 40 (2014)
||Allows for up to four public health demonstration projects for innovative, evidence-based approaches to provide outreach, HIV and hepatitis C screenings, and linkage to, and retention in, quality health care for the most vulnerable and underserved individuals with a high risk for HIV infection.
|CO SB 14-173 (2014)
||Recommends that health care providers offer hepatitis C screenings to people born between 1945-1965. Effective August 6, 2014.
|CT HB 257 (2014)
CT ALS 203
|Requires primary care providers to offer hepatitis C screenings to people born between 1945-1965. Effective October 1, 2014.
|MA Chapter 165 of 2014 Acts
||Requires primary care providers to offer hepatitis C screenings to people born between 1945-1965.
|NY AB 1286
Chapter 425 (2013)
|Requires the offering of hepatitis C screening for anyone born between 1945 and 1965 receiving services as an in-patient, outpatient, or emergency room hospital setting. Allows for exceptions in emergency situations or if the person has already been tested and/or cannot give consent.
|NY AB 9124-S6871
|Allows nurse practitioners and physicians to issue non-patient specific order to administer hepatitis C tests.
|WA SB 6002 (2013) Chapter 221
||Updates the state's hepatitis C strategic plan, to be completed by September 15, 2014, which will include plans to target screening to those born between 1945 and 1965.
|OTHER STATE ACTIONS
||Governor signed proclamation, recognizing Hepatitis C Awareness Month, May 21, 2014
||Governor Kasich signed resolution, recognizing World Hepatitis Day, July 28, 2014
Governor Haslam signed proclamation, recognizing Hepatitis Awareness Day, July 28, 2014
House of Representatives passed proclamation, recognizing World Hepatitis Day, July 28, 2014
- NCSL LegisBrief: Treating Hepatitis C, October 2014. An overview of state actions pertaining to screening and treating for hepatitis C.
- NCSL Audioconference- Hepatitis C Treatment Breakthroughs: Policy Considerations. Recorded September 26, 2014. NCSL will held an informational call to provide legislators and legislative staff an opportunity to hear about policy considerations related to hepatitis C. State-supported programs like Medicaid, state employee health insurance plans and prisons may take a measured approach to coverage of these treatments. Hear the latest about hepatitis C treatment guidelines, policy considerations by Medicaid programs, private insurance plans and others. Click here or title above for audio archive.
- Delegate Don Perdue, West Virginia
- Dr. John Ward, director, Division of Viral Hepatitis, Centers for Disease Control and Prevention
- Matt Salo, executive director, National Association of Medicaid Directors
- Carmella Bocchino, executive vice president, Americas Health Insurance Plans
- Sara Radcliffe, executive vice president for Health, Biotechnology Industry Organization
- NCSL Postcard- Baby Boomer Screening for Hepatitis C. July, 2014
NCSL Audioconference- Hepatitis C: The Fundamentals. Recorded July 25, 2014. NCSL held an informational call to provide legislators and legislative staff with basic and fundamental information about the hepatitis C virus. Speakers included Guy W. Neff M.D., Medical Director of Hepatitis C at AbbVie and Coy A. Stout, Vice President of Managed Markets at Gilead Sciences who provided information and answered questions from participants.
Resources and News Items*
- What Everyone Should Know About Hepatitis C: Provided by Gilead Sciences Inc.
- American Liver Foundation: Hep C 1, 2, 3
- American Association for the Study of Liver Diseases and Infectious Diseases Society of America (IDSA), in collaboration with the International Antiviral Society-USA (IAS-USA) up-to-date guidance for the treatment of hepatitis C virus infection
- American Association for the Study of Liver Deseases: HCV Treatement Recommendations Now Includes Information on Prioritizing Patients Under Limited Resources
- amfAR Opioid & Health Indicators Database- includes information about Hep C transmission rates, cases, and other information as it relates to the opioid epidemic.
- BIO-Tech Now- Jim Greenwood, BIO President and CEO, featured in a roundtable hosted by PA Congressman Joe Pitts to discuss new ways to expedite new cures for patients in need. Coverage provided by C-SPAN.
- CDC Hepatitis Home Page
- CDC Hepatitis C Home Page
- CDC Testing Recommendations
- CDC Recommendations for prevention and control of Hep C
- CDC Foundation: Viral Hepatitis Action Coaltion
- Centers for Medicare and Medicaid Services: Assuring Medicaid Beneficiaries Access to Hepatitis C (HCV) Drugs
- Centers for Medicare and Medicaid Services Decision Memo for Screening for Hepatitis C Virus (HCV) in Adults
- California Technology Assessment Forum: The Comparative Clinical Effectiveness and Value of Simeprevir and Sofosbuvir in the Treatment of Chronic Hepatitis C Infection
- Colorado Department of Public Health and Environment Hepatitis Data Reports
- Connecticut Office of Legislative Research: Research Report- Hepatitis C (report addresses a series of questions about hepatitis C for a legislative audience)
- HepVu- HepVu offers interactive online maps that visualize the Hepatitis C epidemic across the country. Created by Rollins School of Public Health at Emory University in partnership with Gilead Sciences, Inc.
- IDSA: Hepatitis C Guidance Underscores the Importance of Treating HCV Infection: Panel Recommends Direct-Acting Drugs for Nearly All Patients with Chronic Hepatitis C | - See more
- Kaiser Permanente: Successful Hepatitis C Treatment Lowers Subsequent Medical Costs
- U.S. Preventive Services Task Force - Screening for Hepatitis C Virus Infection- Grade: B Recommendation
- National Alliance of State & Territorial AIDS Directors (NASTAD)- Viral Hepatitis Information
- National Association of Medicaid Directors statement about Evidence-Based Reporting Critical to Decisions on Sofosbuvir and Health Care Innovations
- PricewaterhouseCoopers LLC- The Cost of Innovation: A Closer Look at Specialty Drugs
- Public Health Law Research: Public Health Departments and State Patient Confidentiality Laws Map (includes Hep C)
- Oregon Health and Science University Report: Sofosbuvir for the Treatment of Hepatitis C and Evaluation of the 2014 American Association for the Study of Liver Diseases Treatment Guidelines, May 2014
- “Hepatitis C in the United States.” S. Holmberg, P. Spradling, A. Moorman and M. Denniston. New England Journal of Medicine. May 2013.
Objective: Discuss the latest data from the Chronic Hepatitis Cohort Study (CHeCS) and National Health and Nutrition Examination Survey (NHANES) studies and the implications of hepatitis C testing and treatment in the U.S.
- “Patient Characteristics and Utilization of Protease Inhibitors in Hepatitis C Virus (HCV) Patients in a Large Payer Database.” N. Tandon, C. Gunnarsson and A. Prabhakar. Janssen Scientific Affairs, LLC. Presented at the European Association for the Study of the Liver (EASL) International Liver Congress. April 2013.
Objective: Investigate demographics and disease characteristics of hepatitis C patients, their comorbid conditions, and their treatments and associated expenditures using a large healthcare payer database.
- “The Costs and Benefits of HCV Testing and Treatment in Perspective.” D. Rein. Presented during the U.S. CDC/Viral Hepatitis Action Coalition’s (VHAC) 2014 National Summit on Hepatitis C Prevention and Cure. June 2014. Atlanta, Ga.
Objective: Summarize cost-effectiveness of new hepatitis C treatments, as well as budgetary challenges, potentional solution areas of uncertainty.
*NCSL has gathered information from many health-related blogs and organizations that study this issue. Some of these resources may come from an advocacy or industry perspective, and inclusion on this list does not imply an endorsement from NCSL.