Treatment can cause serious physical and psychological side effects. The US Food and Drug Administration last week issued a warning that Incivek can cause severe, sometimes fatal, skin reactions. And there is still no way to distinguish between those for whom the disease will progress to cirrhosis or cancer and those who will experience few effects of infection, LeFevre said. That’s an important distinction from HIV. “The certainty with which we know [those with HIV] will suffer the consequences from that is much higher,” he said. “It’s not exactly a fair contrast.”
Still, some providers are working to implement the CDC recommendation now, and working to destigmatize the screening. Dr. Chris Bositis, clinical director of the hepatitis C program at Greater Lawrence Family Health Center, said the ability to explain to patients that they are being offered a hepatitis C test based on their birth date alone, rather than assumptions about their past behavior or medical history, simplifies the conversation.
The screening becomes “very routine, like being tested for your blood sugar or your cholesterol or any other preventive maintenance thing we do in primary care,” said Dr. Virginia Palazzo of Belmont Medical Associates, who offers the test to baby boomers who come in for a physical exam.
The CDC’s recommendation, if implemented, could be expensive. Testing baby boomers and treating those who are infected with the newest drugs could add an estimated $19 billion to health care costs, according to an analysis funded by the agency and published in the Annals of Internal Medicine.
But that cost in relation to quality years of life gained through treatment is comparable to some other preventive measures already common in primary care, such as cholesterol screening, the study found.
For people like Paul O’Hara of Boston, such a calculation is no abstraction. In 1996, a former girlfriend contacted O’Hara to say she was infected and he later tested positive. After beginning to notice his strength waning as a result of the disease, the 57-year-old recently completed a grueling 11-month treatment that included the drug Incivek. Treatment caused gastrointestinal trouble and paranoia. He lost 20 pounds of muscle, he said, but today the virus is undetectable in O’Hara’s body.
O’Hara talks readily about his prior intravenous drug use. In addition to reaching people like him who have not been tested before, the CDC’s policy is aimed at those who may be unaware they have risk factors, or are reluctant to talk about them. O’Hara said it makes sense to test more baby boomers for hepatitis C.
“I really didn’t know anything about it until I contracted it,” he said. “Then I ended up knowing everything about it.”