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C. Everett Koop, M.D., SC. D.

Former U.S. Surgeon General
Statement on Hepatitis C

community health when prisoners are released into the community. The confinement of a prison offers a suitable environment for treatment, and we should make every effort to test and treat those who are infected.

AIDS - a substantial portion of the HIV-infected population is co-infected with HCV. HCV co-infection interferes with the effectiveness of the protease inhibitors in the new HIV "cocktails." Screening and treatment for HCV should be an important part of the overall HIV treatment protocol.

Specifically, the AIDS Drug Assistance Program, provided for in the Ryan White Act, may be more effectively utilized if HCV treatment is incorporated in the protocol.

Women with a History of C-Section Delivery - Women with no recollection of any history of high-risk activities are beginning to appear in middle age with symptoms of serious liver disease resulting from HCV infection. For a number of these, the trail leads back to blood

transfusions they received unknowingly when they had Cesarean section surgery during childbirth.

Studies in the 1970s and early 1980s indicate that during this time of high risk HCV infection through the blood supply, as many as 20 percent of C-section patients were given transfusions. An estimated 8 to 10 percent of these women would have HCV infection today. This population needs a special effort because it is beginning to develop serious liver disease, and will fall outside the period of the HCV lookback.

Young Adults who were Critically Ill Newborns - The risk of hepatitis C infection is also suspected to be unusually high among persons who were critically ill at birth. From the mid-1970s to the early 1990s, low birth weight and other critically ill babies were routinely given multiple transfusions of small amounts of blood during a period when the blood supply was not screened for HCV. These young people would now be between 5 and 25 years of age. With few exceptions, only the oldest

would be experiencing symptoms of liver disease, making this a particularly consequential group for screening and treatment. Only a portion of this group will be identified through the HCV lookback.

I would like to close by again commending the Secretary of HHS for taking the leadership in making the blood lookback a priority. This will be a substantial and critical undertaking. We cannot afford, however, to get carried away with the lookback effort and miss the imperative of addressing hepatitis C infection more broadly. We need a coordinated federal effort that reaches across the relevant agencies and identifies activities that can be significant in training physicians, raising public awareness, and seeking out target populations for screening and treatment.

I believe we have a 5-year window to identify and treat a significant proportion of the infected population if we are to head off the huge increase of liver disease I believe is ahead.