Hepatitis C Testing- the Fine Print

Yesterday's blog focused on the CDC's new recommendation for ALL BABY BOOMERS to be tested for Hepatitis C, regardless of their other risk factors. The rational is to diagnose this often silent disease early, while treatment can make the most impact saving lives and improving quality of lives. While hepatitis C is largely transmitted via IV drug abuse (which obviously people can identify as a risk factor), there is a significant chunk- usually quoted around 10%- of people who have NO KNOWN risk factors.

So what's the fine print about the testing? First of all, the Hep C test is a blood test (just a heads up for the needle-phobics out there.) Mainly, however, the issues about testing surround the results.

A negative result is wonderful- there is extremely low chance that you have the disease and the test missed it, because this is a very sensitive test.

A positive result, however, leads to a much longer discussion. A positive Hep C Antibody test (the screening test) cannot tell you how long you have been infected. More testing is now required. The next step will be to have a different blood test that measures "viral load"- actually looking for the amount of Hep C virus present in your system. Other blood tests will measure your liver "function" to see if it looks inflamed.  Your doctor may also test to determine the subtype of Hep C in order to better advise you regarding the potential response to therapy. By the way, All positive tests for Hep C will be reported to the health department. This should not to make you paranoid, as your insurance company will obviously know as well, but simply something to note.

If your screening test was positive but your viral load does NOT show any current presence of Hep C, and your liver enzymes are normal- you will be considered to have recovered from a prior Hep C infection, and part of the lucky 15-25% who do not progress to chronic disease.

 If your screening test is positive, your viral load is elevated, but your liver enzymes are normal and you feel fine- you may be a Hep C Carrier, and most people in this category do not require immediate treatment. Carriers are followed closely to be sure they are not having silent worsening of disease (as measured by deteriorating blood tests or symptoms), holding off on treatment until there has been a change.

If your screening test is positive, your viral load is high, and your liver enzymes are abnormal or you have significant symptoms, then you will be heading to a liver specialist to discuss treatments. Though the treatment for Hep C can be challenging, between 50-80% of patients have sustained (successful) responses to treatment, depending on their subtype and how long the disease has been present.

BOTTOM LINE: Baby Boomers should talk with their doctors about getting tested for Hepatitis C, but recognize the results may initially create more additional questions than answers. 

Baby Boomers & Hepatitis C- Are You at Risk?

Yesterday the Center for Disease Control (CDC) announced that all baby boomers (adults born in 1945-1965) should be tested for Hepatitis C in order to increase earlier detection of this often silent disease. The CDC predicts that one in thirty Baby Boomers is infected with Hep C, and that close to a million people will be newly diagnosed if all in this age category are tested. The hope is that this strategy will save over 100,000 lives.

What is hepatitis C? Hep C is a viral infection that primarily targets the liver, and can potentially lead to severe liver damage, cancer and death. The good news is that 15-25% of people infected will "fight off" the disease and not become chronically ill with this disease.

How does someone catch Hep C? This infection is blood-born, so it is transmitted when there is direct blood-to-blood contact such as when people share needles for drug use. Baby boomers who received blood transfusions before 1992 could have been infected then and harbored silent disease for several decades. (Blood transfusions after that time were able to be screened and are safe.) Hep C can also be spread through sex with an infected person, but the transmission rates are very low (as measured in monogamous couples where one partner has hep C and the other does not.) Tattoos are another potential source of transmission. Unfortunately, most studies show that 10% of people with hepatitis C have no identifiable risk factors,  so that is why everyone should be screened regardless of their behavioral risk factors. 


Isn't there a vaccine for hepatitis? For Hepatitis A and Hepatitis B- YES, but not yet for Hep C.

What is the treatment? Unfortunately, the treatment for hep C is not as simple as taking an antibiotic for a bacterial infection, but it is very effective. Hep C treatment typically lasts a year and requires weekly injections, and the medications can have marked and serious side effects (especially fatigue, flu-like symptoms and depression.) Newer medications may offer shorter treatment courses and will be much better tolerated.

How do I get tested? Schedule an appointment to talk with your doctor about getting a blood test for Hepatitis C. The results are not exactly black and white, so you will want to learn more details before you decide...more on this tomorrow.

BOTTOM LINE: New recommendations suggest ALL BABY BOOMERS should get tested for Hepatitis C.

Food Allergies

How many times have you heard someone say that they are allergic to a specific food? Food allergies are indeed common, affecting roughly 8% of kids and around 4% of adults. A true food allergy is an immune reaction to a food protein. There are many food REACTIONS (such as lactose intolerance, for example) that are not true allergies.The most common allergens are PEANUT, FISH, SHELLFISH and other TREE NUTS.

What are signs and symptoms? Food allergies show up within minutes to a couple hours after exposure to even small amounts of the offending protein. Itchy, red rashes, swelling, flushing, nausea, abdominal cramping and diarrhea, stuffy nose, wheezing, racing heart and metallic taste in your mouth are some of the possible presentations.

How do we diagnose food allergies? Mainly by history, to be honest. We combine the history with either skin or blood testing for more accuracy. Skin testing CAN be helpful, but there are many false-positives (which means the test says there IS an allergy, but there is not.) NEGATIVE results on a skin test, however, are very accurate that there is NO food allergy, so that can be very reassuring. Blood tests are also poorly predictive, being accurate only roughly half of the time. We do know, though, that high levels of blood tested antibodies are very suggestive of an allergy to that food.

We do not have a CURE for food allergies, but we can use antihistamines and epinephrine to treat acute reactions.
Of course, the mainstay of treatment is prevention through avoidance of that food protein.

BOTTOM LINE: If you think you may have a true food allergy, discuss it with your doctor and consider additional testing before permanently restricting your diet.

Celiac Disease: Do I Have It?

This week I am talking about celiac disease, a very common problem that affects 1 in 133 Americans. With non-specific symptoms such as fatigue and abdominal bloating, how can it be diagnosed? As is often the case, it is not as clear cut as you might think.

The first caveat is that you must EAT wheat (gluten) for the whole month before you are tested to get the most accurate evaluation. Blood tests are performed that check your antibodies, including the most sensitive test (meaning it will miss the fewest cases, but may have some false positives) anti-tTG (anti-tissue transglutaminase antibody.)

The doctor must also test your IgA levels (immunoglobulin A) because if you are not making adequate IgA, you could test negative for celiac disease even though you have it. Additional blood tests include anti-endomysial antibody (EMA-IgA) and anti-deaminated gliadin peptide (DGP – IgA and IgG).

Ultimately, the diagnosis will need to be confirmed not only with a blood test, but with a small bowel biopsy which is done through endoscopy. The biopsy will look directly at the lining of the gut and determine what level of damage exists.

Alternatively, you can choose to follow a strict gluten-free diet, and if your symptoms resolve, it is likely you have celiac disease (or at least gluten-intolerance.) This is obviously less specific and accurate, but is certainly a good starting place.

BOTTOM LINE: If you are concerned you may have celiac disease, talk with your doctor about getting a simple blood test to help determine if you should go gluten-free.