Older and younger patients infected with hepatitis C (HCV) have different characteristics, and treatment needs to be tailored accordingly. The younger cohort needs much more comprehensive care if we are to eliminate hepatitis C; for the older boomer population, we need to diagnose them early in the course of disease, which means enhancing screening, and then treating them to prevent end-stage liver disease and liver cancer.

Older HCV patients, who have had a long duration of illness, are at risk for end-stage liver disease and liver cancer, but have a lower risk of re-infection after cure. Younger HCV patients have a shorter duration of illness and are less at risk of liver fibrosis in the short term. For younger HCV patients, the most immediate risk to their health relates to co-infection with other viruses, injection drug use, drug overdose, mental health issues, and lack of stable income and housing. For younger HCV patients, treatment must extend beyond direct-acting antiviral therapy to improve health and curb the risk of HCV infection and re-infection. Harm-reduction services such as access to needle exchanges to prevent transmission, opioid-substitution therapy for addition management of addictions, and ongoing counseling are needed, along with strong social services to stop the spread of HCV.

When it comes to hepatitis C virus (HCV), there are are two key groups at risk: Baby boomers, and younger birth cohorts with ongoing risk activities. This is something a Canadian research group calls “twin epidemics” and says that the younger cohort is not getting the attention they need.

Baby boomers are less likely to have ongoing risk activities, but they do have a relatively high burden of disease from infection acquired in the past. They are a clear group to target when it comes to screening and treatment programs, but the younger cohort have a variety of largely unmet needs that warrant attention if the spread of HCV is to be stemmed, according to Naveed Janjua, MBBS, DrPH, senior scientist at the British Columbia Centre for Disease Control in Canada.

“They are a unique group of individuals in which most new infections are happening,” he told MedPage Today. “Treating them is more complicated than simply giving them medical therapy.” He was lead author of a recent large study in BMC Infectious Diseases that elucidated the characteristics of the twin epidemics.

When researchers look at the causes of mortality among this younger cohort, deaths are often related to acquisition-related causes such as injection drug use and drug overdose. Baby boomers, on the other hand, are more likely to present later with HCV and to die from chronic diseases and liver-related causes.

The study used data from the British Columbia Hepatitis Testers Cohort, which includes all individuals tested for HCV or HIV at the BC Public Health Laboratory. Included were data on over 1.5 million people tested between 1990 and 2013, also linked to data on medical visits, hospitalizations, cancers, prescription drugs, and mortality.

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