Hacker News Reader

Comment by shaftoe | Hacker News Reader

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"?

View on HN

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?

>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.

Signs of Hepatitis C, along with most liver diseases, can be caught with the standard liver enzyme tests that's available in pretty much every lab in the developed world.

To be specific, if you see your doctor and it's been more than 6 month since your last visit, then it's standard procedure to take a blood test. Your doctor will take out a pre-printed form that's commonly called "laboratory requisition form" or "assay requisition form", fill out the patient information and tick a few boxes. If they ticked the "ALT" box, then they have ordered the necessary liver enzyme tests. Quoting Wikipedia: "Significantly elevated levels of ALT (SGPT) often suggest the existence of other medical problems such as viral hepatitis, diabetes, congestive heart failure, liver damage, bile duct problems, infectious mononucleosis, or myopathy, so ALT is commonly used as a way of screening for liver problems."[1]

Here's a Kaiser Permanente laboratory requisition form[2] with the ALT checkbox. Here's a Quebec health provider that include ALT in their general profile test #1 through #4 [3].

Testing for Hepatitis C directly is also widely available. Since it's a public health hazard, most state and national governments in the developed world has setup free testing programs. For example, I Googled "california hep c testing" and this page[4] is the third result. They offer _free_ Hepatitis C tests with the results available in 20 minutes.

[1] https://en.wikipedia.org/wiki/Alanine_transaminase

[2] http://testinfo.kaiserpermanente.org/info_assets/cpp_ga/pdfs...

[3] https://www.dynacare.ca/DYN/media/DYN/Pdf/Print%20a%20Form/G...

[4] https://www.sfaf.org/services/sexual-health-and-testing/hiv-...

Forgive a non-bio major, but these tests can generally be segregated into cultured (pcr) / non-cultured, no? And I'm guessing as an enzyme test, this would fall into the later category?

The blocker is generally the cost associated with false positives. If you are low risk for hep C and you get a positive test result it is more likely than not a false positive

This associated cost is what, the price of another, perhaps more expensive, test? That doesn't seem like a big deal...

Also blood transfusions, which could be a wide variety of folks that have had routine surgeries, including, for example, c-sections.

I imagine a fair amount is also from unprotected sex with high risk partners.

"Sexual transmission of hepatitis C is uncommon."

https://en.wikipedia.org/wiki/Hepatitis_C#Sexual_intercourse

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.

Are "regular STI screenings" common in the general population (not sex workers) in absence of symptoms?

I'm not sure about the general population, but this seems to be quite common in the homosexual population, especially among males. The big risk there continues to be HIV, but if you're going to get screened regularly anyway, might as well check for everything else.

(Source: I am a homosexual male.)

I'm not sure there should be all that much stigma attached to it honestly. There are enough non-STI ways to contract some of these diseases that I think it makes sense for even married, faithful, and generally low risk partners to get a round of testing every once in a while.

> There are enough non-STI ways to contract some of these diseases that I think it makes sense for even married, faithful, and generally low risk partners to get a round of testing every once in a while.

Really? Chlamydia, gonorrhea, syphilis? How can you get those without having sex?

I'm not a doctor, so take this with a grain of salt, but generally something classified as an STI has difficulty surviving outside the human body. It's not impossible, and anything that allows that pathogen to get into the bloodstream is a risk factor for the infection to spread. Things like blood transfusions, or unclean practices like needle sharing, could all contribute. Sex is by far the most common means of transmission, but it isn't the only way. It couldn't possibly be; otherwise how would the first human have become infected?

Bad news on chlamydia: it can infect the eye and spread through personal contact.

Some people won’t have unprotected sex with a new partner unless they’ve both been tested. Some people know they’re in a non sex worker risk group and get tested without symptoms.

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.

Reply on news.ycombinator.com