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Abstract Details
Hepatitis C in Injection-Drug Users — A Hidden Danger of the Opioid Epidemic
Lang, TJ, Ward, JW. N Engl J Med 2018 Mar 29; 378:1169-1171.
Much has been written about the escalating crisis of opioid-overdose deaths in the United States and its mounting social and economic costs. Although political and public health leaders have begun to confront this urgent problem, hidden beneath it lies another danger: the increasing spread of hepatitis C virus (HCV) associated with injection-opioid use.
The discovery and understanding of HCV and its complications and the recent development of highly effective treatments with cure rates of greater than 90% are triumphs of modern medicine. But this success has fostered a false sense of security: a “curable” disease is deemed a “conquered” disease that no longer warrants high-priority investment. Opioid-related HCV infection and its sequelae, however, affect growing numbers of people.
Of the estimated 3.5 million Americans with chronic hepatitis C, most are baby boomers born between 1945 and 1965, the vast majority of whom acquired HCV decades ago from blood transfusions, contaminated medical equipment, or parenteral drug use. Most people with HCV don’t know they have it, since HCV-related liver disease often causes few clinical signs or symptoms until its late stages. HCV-related mortality has been increasing for decades — a trend that is especially pronounced for HCV-associated liver cancer. From 2013 on, the number of HCV-related deaths in the United States has exceeded the number of deaths associated with HIV and 59 other infectious diseases combined. Public health actions to prevent HCV-related disease and death are focused on testing baby boomers and other people at risk for HCV and connecting infected people to proper medical care and curative treatment.