Are You Part of the Silent Epidemic?

By Nikki Hayes, MPH
Chief, Comprehensive Cancer Control Branch, CDC


You’ve heard of mammograms to find breast cancer and tests to find colorectal (colon) cancer. But do you know how to help prevent liver cancer?

There’s no screening test for liver cancer. But there is a screening test for hepatitis C, which is the leading cause of liver cancer.

What Is Hepatitis?

Hepatitis is inflammation in the liver that is caused by infection by a virus or by alcohol abuse. There are several types of viral hepatitis. A, B, and C are the most common. Any of the hepatitis viruses can cause liver problems, including deadly liver cancer.

Do You Need to Get Tested for Hepatitis C?

Hepatitis C has been called a “silent epidemic” because most people who have it don’t know they are infected. Also, as addiction to opioid painkillers becomes more common, the number of people with hepatitis C is going up, too.

People born between 1945 and 1965 have 75% of all hepatitis C infections among all adults. So if you saw the Beatles debut, gave peace a chance, or were a disco baby, chances are you’re five times more likely than other adults to have hepatitis C. And we know that liver disease and liver cancer are on the rise.

Finding out whether you have the virus is the first step. Ask your doctor about a test at your next checkup. If you have hepatitis C, there are things you and your doctor can do to help you avoid more severe liver disease or liver cancer.

February Is Cancer Prevention Month!

CDC’s National Comprehensive Cancer Control Program is helping states, territories, and tribal areas in the United States keep their residents over 50—and everyone else, too—up-to-date about ways to help prevent liver cancer.

If you want to know more about hepatitis C, or if you may be at risk for other types of hepatitis, CDC can help.


Speak up for Senate Bill 40 – the Harm Reduction bill!

Senate Bill 40 (SB 40) is a harm reduction bill package being proposed in the Colorado Legislature that passed out of the Opioid Interim Committee with bipartisan support this past fall.  The bill includes naloxone access for school nurses, syringe exchange out of Emergency Departments, and a pilot supervised use site in Denver.
Your advocacy is needed today to support this bill!  SB 40 will next go to the Senate Committee and some of the Senators on that committee need some convincing.
Senator Vicki Marble (, 303-866-4876) needs to hear from HER constituents.  If you live in her district (Firestone, Johnstown, Mead, Broomfield, Erie, Longmont, Northglenn, and Windsor, CO), please contact her to express your support.
For everyone else, please call and email:
Senate President, Kevin Grantham
Senator Grantham has expressed reservations about SB 40 but we need his leadership for a healthier and safer Colorado.
Please also email these three senators on the Senate Committee:
Sample Email:
Subject line: Support SB 40!!

My name is X, I live in (insert city/county/zipcode) and I am emailing you today in support of SB 40 and asking that (insert Senator’s name here) vote yes!! I strongly support harm reduction public health policies in Colorado and I really, really want to see this bill pass.

I join the voices of treatment providers, drug users, recovery community, businesses, faith community, moms, and so many more that want to reduce the amount of overdose deaths in Denver and in the state of Colorado.  Coloradans die in our state of overdose every 9 hours and 36 minutes.  Access to Naloxone in schools, syringe exchange out of Emergency Departments, and the opportunity for a Denver pilot for supervised use site is the direction that I would like to see Colorado take in the midst of this epidemic.  Your yes vote will save lives.  Sincerely, (you).

Hepatitis C – It’s About More Than Liver Disease

The “Hepatitis C – It’s About More Than Liver Disease” project of the National Viral Hepatitis Roundtable (NVHR) aims to increase awareness among the healthcare and patient communities about the extrahepatic manifestations (EHMs) associated with chronic Hepatitis C virus (HCV) infection. Through the provision of educational materials and opportunities to engage in discussion, the project promotes the recognition of HCV infection as a systemic disease that requires a comprehensive approach to care in order to improve patient health outcomes.


Fact Sheet 1 – Health Effects of Hepatitis C Outside of the Liver

Study Backs Hepatitis C Treatment in Injection Drug Users

By Amy Orciari Herman

Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH

Use of sofosbuvir-velpatasvir to treat hepatitis C virus (HCV) infection in injection drug users usually leads to a sustained virologic response at 12 weeks, according to an industry-supported study in the Lancet Gastroenterology & Hepatology.

Some 103 patients with chronic HCV infection (types 1–4) who reported injection drug use in the prior 6 months received sofosbuvir-velpatasvir once daily for 12 weeks. At baseline, three-quarters had injected drugs in the past month. Roughly 60% of participants were receiving opioid substitution therapy during the study.

Of 100 participants who completed treatment, 99 had an end-of-treatment response. The primary outcome — sustained virologic response 12 weeks later — occurred in 94% of all participants. Of the three participants who completed treatment but didn’t achieve the primary outcome, two were lost to follow-up and one had HCV reinfection.

Commentators note that although guidelines recommend HCV treatment for drug users, “stigma … has resulted in insurance restrictions and reluctance from providers to offer appropriate medical therapy.” They conclude that HCV-infected injection drug users “can and should be treated with direct-acting antivirals.”

Follow-up of this cohort is ongoing.


HCV Screenings Spike after Prompt in Electronic Health Record

by Kenneth Bender

A best practice advisory (BPA) displayed in the electronic health record (EHR) of baby boomer patients in a multi-site healthcare system prompted a 5-fold increase of screening for hepatitis C virus (HCV) in the population that, according to the Centers for Disease Control and Prevention (CDC), has a 5-fold higher prevalence of HCV than other age groups.

Low screening rates for baby boomers in clinical practice have been noted in multiple studies, in spite of the CDC’s and US Preventive Services Task Force’s recommendation years ago, Monica Konerman, MD, Gastroenterologist and Clinical Lecturer, University of Michigan Hospitals and Health Centers, Ann Arbor, MI, told MD Magazine.


CO Medicaid drops fibrosis score restrictions for hep C treatment!

The Department of Health Care Policy and Financing has proposed new criteria for hepatitis C (HCV) treatment to take effect January 1, 2018. Under the new criteria, Colorado Medicaid will no longer require patients with HCV to have a fibrosis score of F2 or higher before being approved for treatment.  Patients with fibrosis scores of F0 and F1, indicating no or minimal liver scarring or inflammation, would now be approved for HCV treatment through Medicaid.
The new criteria also states that re-treatment of HCV for patients for whom treatment previously failed “will be reviewed on a case-by-case basis.”  Previously, the state Medicaid program would only approve a once-per-lifetime treatment using direct acting antivirals to treat HCV.
The criteria still requires that patients who abuse or misuse alcohol or controlled substances be in substance use counseling or treatment for 1 month prior to starting treatment.  Maintaining this requirement goes against the recommendations of the Drug Utilization Review Board which recommended in November dropping the 1 month minimum and replacing it with enrollment in substance use treatment for any length of time.
Retaining this treatment restriction for people who use controlled substances will unfortunately prevent many of the individuals who are most likely to transmit HCV to others from being cured.
Nonetheless, these changes represent a major step forward in the goal of ensuring HCV treatment for all!


Hep C: The State of Medicaid Access

The Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) and the National Viral Hepatitis Roundtable (NVHR) launched the Hepatitis C: The State of Medicaid Access project.

This project includes a report that details hepatitis C treatment access restrictions in Medicaid programs in all states, the District of Columbia and Puerto Rico, including traditional fee-for-service as well as managed care. The report focuses on three of the most significant restrictions to treatment: liver damage, sobriety, and prescriber limitations. It is the most comprehensive public listing of these restrictions to date.

NVHR also issued report cards for each state Medicaid program. These report cards grade each state based on its restrictions and include recommendations for improving access to hepatitis C treatment.  Colorado received a C+.

These materials are available for download at The website also has a petition for advocates to sign calling for open access and will have media articles, resources and other materials.



Viral Hepatitis in Colorado: 2016 Surveillance Report

The Colorado Department of Public Health and the Environment released their 2016 Viral Hepatitis Surveillance Report.
The report documents increases in hepatitis B and hepatitis C cases in Colorado.  New cases of hepatitis C were especially pronounced among young people who inject drugs.  From 2012-2016, more than half of all reported acute hepatitis C cases in Colorado were among people who inject drugs.

Hepatitis C Screening May Boost Opioid Treatment Success

By Robert Preidt, HealthDay Reporter

FRIDAY, Oct. 20, 2017 (HealthDay News) — Opioid abuse therapy may be more effective if patients are screened for hepatitis C as part of the program, a new Canadian study says.

The research found a sharp drop in opioid abuse among patients after they were told they tested positive for the hepatitis C virus (HCV). Hepatitis C causes liver disease that can lead to cirrhosis (scarring of the liver), liver cancer and liver failure, the researchers said.


“Our study showed awareness of HCV infection among this particular population may motivate them to reduce their consumption and hopefully high-risk behavior,” said lead investigator Dr. Hooman Farhang Zangneh, a postdoctoral research fellow at the Toronto Centre for Liver Disease at Toronto General Hospital.


Hepatitis C Testing Rates and Care Quickly Increase After Adoption of State Law

By Amy Orciari Herman

Edited by André Sofair, MD, MPH, and William E. Chavey, MD, MS

A New York State law requiring healthcare providers to offer hepatitis C virus (HCV) antibody testing to patients born between 1945 and 1965 led to rapid increases in HCV testing and linkage to HCV care. The findings appear in MMWR.

The law, enacted in 2014, mandated that clinicians in primary care or inpatient settings offer HCV screening to age-appropriate patients who hadn’t been offered screening previously. (Since 2012, the CDC has recommended one-time HCV testing for this population.)

Laboratory data showed a 51% increase in the number of specimens collected for HCV testing in this age group during the first year of the law’s implementation, compared with the prior year. A similar increase was seen among Medicaid patients alone. In addition, the percentage of patients with newly diagnosed HCV infection who were linked to care increased by 40% (from 24% to 34%) between the two periods.

Read more here