I’m working on direct-to-consumer STD testing in JasonHealth.com . Some thoughts on Hep C testing:
Hep C Antibody is a very inexpensive test. We charge $25 for it.
It takes a long time for the body to produce the antibodies after infection. This test is only 90% sensitive after 12 weeks ( https://www.hepatitisc.uw.edu/go/screening-diagnosis/acute-d... ). Testing shortly after possible infection with this test is not effective.
The best early detection test is Hepatitis C Viral RNA, Quantitative, Real-Time PCR. It’s able to detect infection 2 weeks after.
The absolute best testing protocol after suspected infection is what doctors use for needle-stick. Test the person who may be spreading the infection immediately using the RNA test. If RNA is detectable start the short course of Hep C drugs on the person who might be infected. This will avoid acute Hep C infection altogether.
Hep C testing is very popular direct-to-consumer. For us, patients usually get it as part of full STD screening ( https://www.jasonhealth.com/l/std-testing ). About 80% of Hep C tests are ordered as part of that.
Anecdotally, it’s not usually ordered by MDs as part of STD screening. Hopefully, these new guidelines will change that.
> It takes a long time for the body to produce the antibodies after infection. This test is only 90% sensitive after 12 weeks
That's not much of a problem except for people worried about infection after a single known exposure (e.g. needlestick in a medical setting).
About a third of patients spontaneously clear the acute infection within six months. On top of that, some countries (such as Germany) refuse to treat acute infections with antivirals - so patients have to wait 6 months for the infection to develop into a chronic infection before they can take the medicine which cures it.
It would be really great if you guys were to partner with other helping infrastructure, such as recovery centers, salvation army, homeless shelters etc...
Getting more people tested for treatments on all levels is a good thing, IMO
Like many of you, I'm a young and healthy guy. I haven't taken a sick day in years. Since I'm young and healthy, I didn't see the need to take an annual physical exam. Scheduling doctor's appointments is such a hassle. I'm sure many of you feel the same.
So when I was diagnosed with Hepatitis C, it came as a complete shock to me. The shock was due to two reasons:
1. I wasn't involved in any of the "high risk" activities associated with Hepatitis C, which are intravenous drug use and tattoos.
2. I regularly went to the doctor's when I was a child, so there was at least 20 blood tests done back then. None of tests caught the Hepatitis C back then.
Since Hepatitis C is a chronic condition for most people, if I didn't catch mine early, it would have been found much later in life when all of the damaged has been done. I only caught my Hepatitis C because I wanted to an elective cosmetic medical procedure. It was my own vanity, plus pure luck, that caught it.
When I was a child, I was covered under the government's and my parents' health care plans. When I entered college, I was enrolled under the mandatory student health care plan. After I entered the work force, I was covered under my employer's health care plan. All this health care was fully paid for, either through tax dollars, or my parent's contributions, or my own contributions, and I stupidly chose not to utilize it, because I was young and healthy.
If you don't want to end up like me, then please heed my advice: all of you are under-utilizing the medical services that you have already paid for. You should research what kind of screening and preventive care is included in the health care plan that you purchased and then take full advantage of them. It's better for you since you live longer. It's better for your insurance company since screening and preventive care is much cheaper than paying for treatments down the road. It's better for your government since they get to collect more tax dollars over your longer lifespan. And it's better for me since I make a living using the software and services that you guys provide.
I can stick around and do a AMA if you guys have any questions for me.
Did you ever figure out why you got HepC? Did you conclude that you had it from birth, or did you remember that you stepped on a nail while traveling in Vietnam?
So what do they conjecture was the means of contracting it?
Excellent write-up, btw, and thanks for it. Totally agree with use-what's-been-paid-for regarding checkups, as it's a win-win all around, for everyone.
I used to do HCV research in British Columbia. Something that might be useful for you if you haven't yet started treatment is to see if you qualify for a settlement. In BC in particular there was a class action lawsuit the compensated people infected from blood products (between 1986 and 1990) [1]
"""
...clinicians are now able to successfully cure at least 95% of patients with the chronic condition with oral medications that have little or no side effects.
"With such an effective means for cure, it only makes sense to universally screen patients," Cheung said. "Implementation of universal screening will also decrease the likelihood of primary care physicians forgetting who does or does not need screening -- and it avoids the sometimes uncomfortable discussion with the patient about why they have been labeled as high risk and needing further screening."
"""
I think the fact that high risk populations rock the medical boat so globally already makes medicine awkward regardless of avoiding uncomfortable discussions. All these blanket treatments and tests just paper over the fact that there are wide impacting subpopulations with poor health in our populous driving the need for these things in the first place. It's the next immediate question that gets raised when you evaluate 'why do I need another HIV test' or whatever other blood test it is that medicine pushes on you. Eventually it dawned on me that these blind blanket decisions are simply because these doctors don't know anything about a patient's personal life and what risky subpopulations they may or may not belong to. But from the patient who knows what virtue they live or don't live some of these tests just come off as absurd knowing your own life history and the absolute absence of risks you deliberately avoid in life. One step of indirection is not much to jump over for one who naturally asks the next immediate question.
> Eventually it dawned on me that these blind blanket decisions are simply because these doctors don't know anything about a patient's personal life and what risky subpopulations they may or may not belong to.
The question is not which subpopulations the patient may belong to, but which ones they may have had contact with. It doesn't matter how well-off you are if you ate dinner last night in a restaurant where the staff cannot afford to be screened and treated for hepatitis. That particular transmission vector is more relevant to Hep A than Hep C, but the general point for public health policy at a high level is sound: you cannot ignore under-served populations that live amongst you, because people you don't care about can still get you sick. Yes, there are some nasty diseases that for now appear to be limited to only sexual and needle transmission, but we shouldn't shape our entire approach to public health around blaming the victims of those particular diseases.
All these blanket treatments and tests just paper over the fact that there are wide impacting subpopulations with poor health in our populous driving the need for these things in the first place.
Sure, some portion of people in distress contribute overall very disproportionately to health care cost. This includes people who make poor health choices (over-consumption of sugary beverages, unhealthy drug and similar things), people who are homeless and people who chronic health problems (through work-related injuries, random chance or actual poor decisions).
There seem to be two reaction: "OK, then just don't allow them health care, problem solved" or "we need to prevent people from getting into that position in the first place."
I would say the first reaction is counter-productive, poorly thought-through and morally indefensible. Obviously, I think the second approach is crucial (obviously requiring quite a bit of effort). The first position is very common, however and it's kind of sad, for both the people who think this way but much more for the consequence.
I think the only reason people jump to the first position is: A. The situation is presented in isolation and these people aren't considering the consequences. B. There's a human tendency to jump to a belief without fully exploring the evidence. C. Defending a belief often just makes the defender more defensive, especially since changing would make them admit they holding a fairly cruel and immoral position.
I think the article from a couple days ago about human belief formation is very relevant for this discussion.
Antiviral drugs for hepatitis C are very effective, but they come at a steep cost. Just one Sovaldi pill costs $1,000. A full 12-week course of treatment with this drug costs $84,000.
The price of other hepatitis C drugs is also high:
Harvoni costs $94,500 for a 12-week treatment
Mavyret costs $39,600 for a 12-week treatment
Zepatier costs $54,600 for a 12-week treatment
Technivie costs $76,653 for a 12-week treatment
My dad passed away in August due to Hep C complications. Very true that anyone who has done anything that can put you at risk should be tested. The treatment is criminally expensive but it is curable with it. Sadly my dad, the a-typical medically procrastinating male, didn't start on Sovaldi until it was too late and he died before he could complete treatment.
> 70% to 90% of older injection-drug users are infected.
If you have the unique misfortune of being born to one of those older users, do get tested. I was asymptomatic when I tested positive a few years ago, at the age of 25. It was a surprise to the medical professionals involved, as I have no drug using history, no tattoos, in otherwise perfectly good health.
I did get the super expensive pills, and they cured me in eight weeks (and I'm extremely grateful my insurance at the time covered the cost).
My liver's doing OK, but who knows whether the disease contributed to my chronic depression. Still, I consider myself lucky to have caught it when I did.
I get their point about stigma, but as someone who has never injected drugs, I'm having a hard time caring about getting screened for this.
How do they intend to actually roll out a massive testing operation (everyone under 80) when likely most people hear the details and respond with "meh, not me"?
There are more details than merely having injected drugs. Blood transfusions have spread Hep C in hospital settings before widespread knowledge of the disease. Infected mothers can pass it to children through childbirth. The disease wasn't even identified until, what, late 1980s? Meaning that there are people who contracted it before then who may not know.
The U.S. Preventive Services Task Force doesn't roll out any screening programs, their job is simply to make clinical recommendations.
So they are saying to clinicians "if you have a patient between 18 and 80 then current evidence suggests that screening for Hep C is more beneficial than harmful on a large scale, even if the patient has no symptoms." Plus governments would likely use recommendations to base laws around this stuff, something like passing a law that says "insurance companies must cover the cost of Hep C testing even in the absence of symptoms" and military officials may make Hep C screening as a part of a standard military physical.
Of course, I've found most clinicians ignore evidence based recommendations, but that's a different topic entirely....
From a public health perspective, recommendations and guidelines like this drive insurance company policies and government funding priorities. Or in other words, the things that actually move the needle when you're trying to get something done for an appreciable percentage of citizens.
There's no ability and need to test everyone today, but this is a sign that we should move to more regular screening of higher percentages of the population.
Honestly, I'm kind of curious from those involved in the field: What's the blocker to rolling out extremely broad, minimal-cost testing? Manual processes? Too few companies in the testing market? Requires expensive prep / reagents?
I didn’t read this as advocating for everyone to run to get tested immediately. This is more a call to healthcare professionals to advocate for this testing.
One way this can roll out is when sexually active adults who are considered low risk for HepC hopefully do their regular STI screening, either they or their healthcare provider can request a HepC test.
Seconded. I have zero risk factors: no tattoos, sex, drugs, cuts on suspicious objects, etc. There is no reason for me to get tested to avoid someone else being uncomfortable. The value of the comfortability of a random stranger to any one is near-zero.
WebMD (https://www.webmd.com/hepatitis/digestive-diseases-hepatitis...) says that 3.9 million people in the US have this disease, more than 1 in 100 of the population. And https://hepatitisc.net/what-is/statistics/ says that worldwide abou 70 million, again roughly 1 per 100. This seems rather a lot. What is missing from the statistics I have been able to find is any breakdown by location, lifestyle, diet, etc. The only hint is that the majority of injection-drug users are infected and that poor blood screening in the past has contributed.
If this disease is so widespread it seems to me that public health measures that prevent or reduce the risk of infection must, in the long run at least, be necessary.
What measures might they be and is there anything that an individual can do to reduce their risk?
The "reportable disease" qualifier must be an important distinction here. The article doesn't say how many Hep C deaths there are, but a search showed about 19,000 annually. That's a far cry from 50,000 estimated pneumonia deaths, and still just under the estimated 20,000 MRSA deaths.
The article says nothing about the false positive and false negative rates of the test, and proceeds as if the screening is infallible.
Even given what was said in the article, one has to assume that the incidence of the infection in the general population is quite low—probably measured in basis points—which means that the false positive rate of the test would have to be very low to get a high positive predictive value. It may well be so, but we'd need to know that (and the costs of treating the uninfected) to understand whether universal testing is really warranted
Hep C is a curable disease that doesn’t have any symptoms. It also tends to infect the most vulnerable among us - heroin addicts.
So the root cause of this issue is not the disease itself but our society and health system. These victims are not receiving the testing and treatment they need because they choose not to or (more likely) can’t afford to go to the doctor.
From a purely epidemic control point of view the most rational path is to test this population as often as possible (every 6 months or less) and treat them immediately if testing positive. If you find people that reinfect rather than a bad thing this means you are being able to reach a core at-risk group.
My mom is a physician who has treated hepc for years. But the problem these days is convincing insurance companies to pay for the treatment. Unfortunately having the disease isn't enough for them pay. :-/
This is likely going to be an unpopular question and maybe I m just really naive, but is the protein really so complex to synthesize that a kit could not be made to make a small batch at home? I ask this because I have recently been studying what is required to produce non naturally occurring amino acids and while not trivial, it can be done. Are there not biohackers that figure these things out as a hobby? I know, totally unsafe, but if your only other option is death, then I think such discussions should be on the table. Derivative works so to speak.
I paid $1300 for a 12 weeks course of generic Harvoni from India. I paid using credit card and it arrived within a week. Normally I'm a law-abiding citizen, but as you said, if it comes down to choosing between violating intellectual property laws and death, it's an easy choice to make.
That's a great question. In this case, the drugs are small-molecules (https://en.wikipedia.org/wiki/Ledipasvir/sofosbuvir) and they're complicated ones at that. So trying to make that at home would be impractical.
But you're on to something I've been personally interested in for a while. You can make proteins at home in cells, but to get them pure enough for injection is near impossible without expensive manufacturing equipment and testing equipment. I think the real win is going to be using mRNA coding for the protein of interest formulated in lipid nanoparticles. This type of idea would be easier to make sterile and have basically no risk of endotoxin/virus issues recombinant proteins have. I give it 10 years before garage biohackers start really getting this idea to work.
I worked for 5 years doing epidemic modeling for HCV, from right around when the first generation of the modern treatments became available (Sofosbuvir, etc). When I started working it was immediately clear that Sofosbuvir et al were a total game changer, and for a while my research was based on figuring out who to treat first: people very sick but that were not spreading the disease, or people with few symptoms that were actively spreading the disease
Here are a few interesting things (in my opinion) that are not so well known about HCV:
- Prior to 2015 you could cure HCV, the standard of care was ribavirin with pegylated interferon. If you were lucky and had the right HCV genotype you would take a whole bunch of pills and injections for 48 weeks, with a 50% chance of cure. The side effects were pretty bad though, people I met that took it compared it to chemo.
- Currently there are treatments available that will cure any HCV genotype, on people with advanced liver disease (cirrhotic), coinfected with HIV, with >95% success rate. One pill per day with basically no side effects.
- In western countries there are a whole bunch of HCV positive baby boomers, in many cases unaware that they are infected. Epidemically they are not transmitting the disease, but they have been chronic for many years and are having liver issues
- Again in western countries, the epidemic is being driven mostly by active intravenous drug users, typically young, and often with other co-morbidities (mental health issues, HIV, etc). Re-infection is possible, so HCV eradication will be tough
- There is controversy as to whether you can transmit HCV sexually, at the least it is much harder than transmitting HIV. Conversely active intravenous drug users that share needles will almost certainly have HCV, with HIV being harder to transmit this way
- In other countries the situation can be very different. Egypt in particular has around 20% HCV prevalence, the story goes that the UN funded a program to eliminate schistosomiasis in the 1980s via vaccination, but the campaign did a lot of shared needles
The recommendation was issued by the U.S. Preventive Services Task Force who is funded by the American government whose job it is to issue evidence based preventive medical recommendations for only the American population based on data relevant to the American population. The U.S. Preventive Services Task Force has neither the authority nor the funding to make Hep C testing recommendations for other countries.
Other countries may have similar issues and their medical task forces may issue similar recommendations, or Hep C might be extremely uncommon in other countries and their medical task force may make different recommendations.
That was the scope of the report. From the first paragraph of the submission:
> "The hepatitis C virus now kills more Americans than all other reportable infectious diseases combined -- including HIV. Acute cases of HCV have increased 3.5-fold over the last decade, particularly among young, white, injection drug users."
Wikipedia has a brief summary, but it is a similar issue as we see with colds and HIV: a highly variable exterior shell for the virus. About six years back, scientists found one region that is mostly "conserved," the docking station that latches onto a particular receptor in liver cells.
Hepatitis C, like HIV, comes in different groups, and it has six to target.
[+] [-] oleg_k|6 years ago|reply
Hep C Antibody is a very inexpensive test. We charge $25 for it.
It takes a long time for the body to produce the antibodies after infection. This test is only 90% sensitive after 12 weeks ( https://www.hepatitisc.uw.edu/go/screening-diagnosis/acute-d... ). Testing shortly after possible infection with this test is not effective.
The best early detection test is Hepatitis C Viral RNA, Quantitative, Real-Time PCR. It’s able to detect infection 2 weeks after.
The absolute best testing protocol after suspected infection is what doctors use for needle-stick. Test the person who may be spreading the infection immediately using the RNA test. If RNA is detectable start the short course of Hep C drugs on the person who might be infected. This will avoid acute Hep C infection altogether.
Hep C testing is very popular direct-to-consumer. For us, patients usually get it as part of full STD screening ( https://www.jasonhealth.com/l/std-testing ). About 80% of Hep C tests are ordered as part of that.
Anecdotally, it’s not usually ordered by MDs as part of STD screening. Hopefully, these new guidelines will change that.
[+] [-] chimeracoder|6 years ago|reply
That's not much of a problem except for people worried about infection after a single known exposure (e.g. needlestick in a medical setting).
About a third of patients spontaneously clear the acute infection within six months. On top of that, some countries (such as Germany) refuse to treat acute infections with antivirals - so patients have to wait 6 months for the infection to develop into a chronic infection before they can take the medicine which cures it.
[+] [-] samstave|6 years ago|reply
It would be really great if you guys were to partner with other helping infrastructure, such as recovery centers, salvation army, homeless shelters etc...
Getting more people tested for treatments on all levels is a good thing, IMO
[+] [-] burfog|6 years ago|reply
human papilloma virus (HPV), mycoplasma genitalium, trichomoniasis, chancroid (haemophilus ducreyi), Lymphogranuloma venereum (LGV), Methicillin-resistant Staphylococcus aureus (MRSA), molluscum contagiosum, scabies, crabs
[+] [-] hep_c_throwaway|6 years ago|reply
Like many of you, I'm a young and healthy guy. I haven't taken a sick day in years. Since I'm young and healthy, I didn't see the need to take an annual physical exam. Scheduling doctor's appointments is such a hassle. I'm sure many of you feel the same.
So when I was diagnosed with Hepatitis C, it came as a complete shock to me. The shock was due to two reasons:
1. I wasn't involved in any of the "high risk" activities associated with Hepatitis C, which are intravenous drug use and tattoos.
2. I regularly went to the doctor's when I was a child, so there was at least 20 blood tests done back then. None of tests caught the Hepatitis C back then.
Since Hepatitis C is a chronic condition for most people, if I didn't catch mine early, it would have been found much later in life when all of the damaged has been done. I only caught my Hepatitis C because I wanted to an elective cosmetic medical procedure. It was my own vanity, plus pure luck, that caught it.
When I was a child, I was covered under the government's and my parents' health care plans. When I entered college, I was enrolled under the mandatory student health care plan. After I entered the work force, I was covered under my employer's health care plan. All this health care was fully paid for, either through tax dollars, or my parent's contributions, or my own contributions, and I stupidly chose not to utilize it, because I was young and healthy.
If you don't want to end up like me, then please heed my advice: all of you are under-utilizing the medical services that you have already paid for. You should research what kind of screening and preventive care is included in the health care plan that you purchased and then take full advantage of them. It's better for you since you live longer. It's better for your insurance company since screening and preventive care is much cheaper than paying for treatments down the road. It's better for your government since they get to collect more tax dollars over your longer lifespan. And it's better for me since I make a living using the software and services that you guys provide.
I can stick around and do a AMA if you guys have any questions for me.
[+] [-] crobertsbmw|6 years ago|reply
[+] [-] amelius|6 years ago|reply
[+] [-] jjtheblunt|6 years ago|reply
[+] [-] inasio|6 years ago|reply
[1] https://www.callkleinlawyers.com/class-actions/settled/hepat...
[+] [-] nabnob|6 years ago|reply
What's your experience with treatment? Did your insurance cover it?
[+] [-] juskrey|6 years ago|reply
[deleted]
[+] [-] jxramos|6 years ago|reply
""" ...clinicians are now able to successfully cure at least 95% of patients with the chronic condition with oral medications that have little or no side effects.
"With such an effective means for cure, it only makes sense to universally screen patients," Cheung said. "Implementation of universal screening will also decrease the likelihood of primary care physicians forgetting who does or does not need screening -- and it avoids the sometimes uncomfortable discussion with the patient about why they have been labeled as high risk and needing further screening." """
I think the fact that high risk populations rock the medical boat so globally already makes medicine awkward regardless of avoiding uncomfortable discussions. All these blanket treatments and tests just paper over the fact that there are wide impacting subpopulations with poor health in our populous driving the need for these things in the first place. It's the next immediate question that gets raised when you evaluate 'why do I need another HIV test' or whatever other blood test it is that medicine pushes on you. Eventually it dawned on me that these blind blanket decisions are simply because these doctors don't know anything about a patient's personal life and what risky subpopulations they may or may not belong to. But from the patient who knows what virtue they live or don't live some of these tests just come off as absurd knowing your own life history and the absolute absence of risks you deliberately avoid in life. One step of indirection is not much to jump over for one who naturally asks the next immediate question.
[+] [-] wtallis|6 years ago|reply
The question is not which subpopulations the patient may belong to, but which ones they may have had contact with. It doesn't matter how well-off you are if you ate dinner last night in a restaurant where the staff cannot afford to be screened and treated for hepatitis. That particular transmission vector is more relevant to Hep A than Hep C, but the general point for public health policy at a high level is sound: you cannot ignore under-served populations that live amongst you, because people you don't care about can still get you sick. Yes, there are some nasty diseases that for now appear to be limited to only sexual and needle transmission, but we shouldn't shape our entire approach to public health around blaming the victims of those particular diseases.
[+] [-] joe_the_user|6 years ago|reply
Sure, some portion of people in distress contribute overall very disproportionately to health care cost. This includes people who make poor health choices (over-consumption of sugary beverages, unhealthy drug and similar things), people who are homeless and people who chronic health problems (through work-related injuries, random chance or actual poor decisions).
There seem to be two reaction: "OK, then just don't allow them health care, problem solved" or "we need to prevent people from getting into that position in the first place."
I would say the first reaction is counter-productive, poorly thought-through and morally indefensible. Obviously, I think the second approach is crucial (obviously requiring quite a bit of effort). The first position is very common, however and it's kind of sad, for both the people who think this way but much more for the consequence.
I think the only reason people jump to the first position is: A. The situation is presented in isolation and these people aren't considering the consequences. B. There's a human tendency to jump to a belief without fully exploring the evidence. C. Defending a belief often just makes the defender more defensive, especially since changing would make them admit they holding a fairly cruel and immoral position.
I think the article from a couple days ago about human belief formation is very relevant for this discussion.
see: https://www.youtube.com/watch?v=bvebjL48f-w&feature=youtu.be
[+] [-] yakz|6 years ago|reply
The price of other hepatitis C drugs is also high:
Harvoni costs $94,500 for a 12-week treatment Mavyret costs $39,600 for a 12-week treatment Zepatier costs $54,600 for a 12-week treatment Technivie costs $76,653 for a 12-week treatment
https://www.healthline.com/health/hepatitis-c/treatment-cost...
[+] [-] ZoomStop|6 years ago|reply
[+] [-] thex10|6 years ago|reply
If you have the unique misfortune of being born to one of those older users, do get tested. I was asymptomatic when I tested positive a few years ago, at the age of 25. It was a surprise to the medical professionals involved, as I have no drug using history, no tattoos, in otherwise perfectly good health.
I did get the super expensive pills, and they cured me in eight weeks (and I'm extremely grateful my insurance at the time covered the cost).
My liver's doing OK, but who knows whether the disease contributed to my chronic depression. Still, I consider myself lucky to have caught it when I did.
[+] [-] shaftoe|6 years ago|reply
How do they intend to actually roll out a massive testing operation (everyone under 80) when likely most people hear the details and respond with "meh, not me"?
[+] [-] thex10|6 years ago|reply
[+] [-] astura|6 years ago|reply
So they are saying to clinicians "if you have a patient between 18 and 80 then current evidence suggests that screening for Hep C is more beneficial than harmful on a large scale, even if the patient has no symptoms." Plus governments would likely use recommendations to base laws around this stuff, something like passing a law that says "insurance companies must cover the cost of Hep C testing even in the absence of symptoms" and military officials may make Hep C screening as a part of a standard military physical.
Of course, I've found most clinicians ignore evidence based recommendations, but that's a different topic entirely....
[+] [-] ethbro|6 years ago|reply
There's no ability and need to test everyone today, but this is a sign that we should move to more regular screening of higher percentages of the population.
Honestly, I'm kind of curious from those involved in the field: What's the blocker to rolling out extremely broad, minimal-cost testing? Manual processes? Too few companies in the testing market? Requires expensive prep / reagents?
[+] [-] latortuga|6 years ago|reply
[+] [-] ssorallen|6 years ago|reply
One way this can roll out is when sexually active adults who are considered low risk for HepC hopefully do their regular STI screening, either they or their healthcare provider can request a HepC test.
[+] [-] big_chungus|6 years ago|reply
[+] [-] ken|6 years ago|reply
Of course, you shouldn't donate blood for the purpose of getting tested for a disease.
[+] [-] kwhitefoot|6 years ago|reply
If this disease is so widespread it seems to me that public health measures that prevent or reduce the risk of infection must, in the long run at least, be necessary.
What measures might they be and is there anything that an individual can do to reduce their risk?
[+] [-] ineedasername|6 years ago|reply
[+] [-] jp57|6 years ago|reply
Even given what was said in the article, one has to assume that the incidence of the infection in the general population is quite low—probably measured in basis points—which means that the false positive rate of the test would have to be very low to get a high positive predictive value. It may well be so, but we'd need to know that (and the costs of treating the uninfected) to understand whether universal testing is really warranted
[+] [-] hypewatch|6 years ago|reply
So the root cause of this issue is not the disease itself but our society and health system. These victims are not receiving the testing and treatment they need because they choose not to or (more likely) can’t afford to go to the doctor.
[+] [-] inasio|6 years ago|reply
[+] [-] findyoucef|6 years ago|reply
[+] [-] LinuxBender|6 years ago|reply
[+] [-] hep_c_throwaway|6 years ago|reply
[+] [-] DrAwdeOccarim|6 years ago|reply
But you're on to something I've been personally interested in for a while. You can make proteins at home in cells, but to get them pure enough for injection is near impossible without expensive manufacturing equipment and testing equipment. I think the real win is going to be using mRNA coding for the protein of interest formulated in lipid nanoparticles. This type of idea would be easier to make sterile and have basically no risk of endotoxin/virus issues recombinant proteins have. I give it 10 years before garage biohackers start really getting this idea to work.
[+] [-] inasio|6 years ago|reply
Here are a few interesting things (in my opinion) that are not so well known about HCV:
- Prior to 2015 you could cure HCV, the standard of care was ribavirin with pegylated interferon. If you were lucky and had the right HCV genotype you would take a whole bunch of pills and injections for 48 weeks, with a 50% chance of cure. The side effects were pretty bad though, people I met that took it compared it to chemo.
- Currently there are treatments available that will cure any HCV genotype, on people with advanced liver disease (cirrhotic), coinfected with HIV, with >95% success rate. One pill per day with basically no side effects.
- In western countries there are a whole bunch of HCV positive baby boomers, in many cases unaware that they are infected. Epidemically they are not transmitting the disease, but they have been chronic for many years and are having liver issues
- Again in western countries, the epidemic is being driven mostly by active intravenous drug users, typically young, and often with other co-morbidities (mental health issues, HIV, etc). Re-infection is possible, so HCV eradication will be tough
- There is controversy as to whether you can transmit HCV sexually, at the least it is much harder than transmitting HIV. Conversely active intravenous drug users that share needles will almost certainly have HCV, with HIV being harder to transmit this way
- In other countries the situation can be very different. Egypt in particular has around 20% HCV prevalence, the story goes that the UN funded a program to eliminate schistosomiasis in the 1980s via vaccination, but the campaign did a lot of shared needles
AMA I guess
[+] [-] ineedasername|6 years ago|reply
[+] [-] _ink_|6 years ago|reply
[+] [-] astura|6 years ago|reply
Other countries may have similar issues and their medical task forces may issue similar recommendations, or Hep C might be extremely uncommon in other countries and their medical task force may make different recommendations.
[+] [-] grzm|6 years ago|reply
> "The hepatitis C virus now kills more Americans than all other reportable infectious diseases combined -- including HIV. Acute cases of HCV have increased 3.5-fold over the last decade, particularly among young, white, injection drug users."
[+] [-] xvilka|6 years ago|reply
[+] [-] at_a_remove|6 years ago|reply
Hepatitis C, like HIV, comes in different groups, and it has six to target.
[+] [-] brobot182|6 years ago|reply
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