SAN FRANCISCO – Hepatitis C–associated deaths are now more common in the United States than HIV-related deaths, according to the Centers for Diseases Control and Prevention.

That’s not just due to improved awareness and treatment of HIV. As deaths from HIV have fallen since 1999 to under 13,000 a year, deaths associated with hepatitis C virus (HCV) have climbed to over 15,000. CDC expects that number to jump to about 35,000 annually within 20 years.

Baby boomers – people born between 1945 and 1965 – currently account for about three-quarters of those who die with HCV-infection, which can take years to manifest as liver cancer or fibrosis.

"This is the population we are very concerned about," said Dr. Jake Liang, president of the American Association for the Study of Liver Diseases and chief of the Liver Diseases Branch of the National Institute of Diabetes and Digestive and Kidney Diseases.

As a result, CDC is poised to recommend one-time HCV screening of all baby boomers, which would be in addition to current screening recommendations for injection-drug users and other high-risk populations, as well as those with unexplained alanine aminotransferase (ALT) elevations, among others. An education campaign, dubbed "No More Hepatitis," also is set to launch next year to boost physician and consumer awareness of HCV, said Bryce Smith, Ph.D., a lead health scientist in CDC’s Division of Viral Hepatitis.

The efforts coincide with the May 2011 approval of two new protease inhibitors for HCV, telaprevir (Incivek) and boceprevir (Victrelis). Both significantly improve sustained viral responses when used in conjunction with peginterferon alfa and ribavirin.

More than 30 HCV agents are in development as well, including some in early phase III trials. The hope is that they will further improve responses, reduce pill burdens, shorten current months-long treatment regimens, and perhaps even end the need for concurrent interferon, a cause of substantial adverse events.

"I think in the next few years, we’ll see a lot of drugs approved," Dr. Liang said.

Meanwhile, "the index of suspicion for hepatitis C infection should be much higher," said Dr. Scott Holmberg, a branch chief in CDC’s Division of Viral Hepatitis.

The agency estimates that half of HCV infections are undiagnosed, largely because current screening recommendations aren’t often followed. "Even when you have a couple of elevated ALTs, about half the time doctors will not test for" hepatitis infection, he said.

"One of the problems is that if someone is drinking and they have an elevated ALT, doctors will think it’s because of the alcohol. Or if they are taking antiretrovirals or statins, that it’s because of the drug. There’s a tendency to dismiss elevated ALT when in fact it should be triggering a test, no matter what you think it’s caused by," Dr. Holmberg said.

CDC’s estimate of HCV-related deaths is based on a review of 21.8 million death records. Any mention of the virus was counted, regardless if HCV was listed as a primary cause of death or simply one of the person’s health problems.