Friday, July 29, 2016

Despite promising treatments, hepatitis C continues to rise

About twice the number of Wisconsinites are living with hepatitis C than have been diagnosed.

About 38,000 Wisconsinites have confirmed cases of the virus, according to the state Department of Health Services' most recent figures from December 2013, though an estimated 74,000 Wisconsin residents are projected to be infected.

And that number is going up, fueled by drug users who contract the virus by sharing infected needles, according to preliminary figures to be released by the Department of Health Services later this month.

Despite the June 28 U.S. Food and Drug Administration approval of Epclusa, a drug certified to treat all strains of the hepatitis C virus, and research out of Spain that calls a combined HIV and hepatitis C vaccine "a possibility," some experts in the field aren't confident the medical changes will lower the number of cases statewide.

Though hepatitis C is highly treatable in its early stages, most people don't know they're infected because the disease is highly asymptomatic, said Rob Striker, a researcher and associate professor of infectious diseases in the University of Wisconsin-Madison School of Medicine and Public Health.

"This is a real problem, not only in the country, but in the state of Wisconsin," he said.
Deadly toll

In May, the Centers for Disease Control and Prevention announced hepatitis C causes more deaths in the U.S. than any other infectious disease. The total number killed from complications with hepatitis C nationwide in 2013 was greater than the number of deaths from 60 other infectious diseases combined.

Baby boomers — born between 1946 and 1964 — who became infected often contracted the disease through tainted blood transfusions before tighter regulations kicked in during the '90s. Now, younger generations make up a new wave of people who contract the disease by sharing infected needles during intravenous drug use.

The number of hepatitis C reports and the rate of heroin overdoses both increased between 2009 and 2014, according to state health department data. While hepatitis C reports in people under 30 — who are most likely to contract it through injection drug use — made up 5% of all state reports in 2003, that number rose to 27% in 2013.

"There's been a lot of misuse and lax prescribing of opiates for pain management," Striker said. "This has led to a resurgence in needle use and hepatitis C transmission."
ADVERTISEMENT


Acute symptoms of hepatitis C can include fatigue, abdominal pain, poor appetite or jaundice, according to the CDC. But most people are asymptomatic for decades, until their infection progresses to chronic liver disease, such as cirrhosis and liver cancer.

Because it's largely silent, Ajay Sahajpal started a screening program in 2014 through Aurora Health Care to pinpoint patients whose medical records showed signs the person could have hepatitis C. So far, 73,000 people have been screened, out of which doctors have found about 600 cases of hepatitis C.

And the more patients tested for hepatitis C while they're still asymptomatic, the quicker they can be cured of the infection.
Costly treatment

Before new drugs infiltrated the market in 2013, the cost of a one-year treatment plan for hepatitis C was about $100,000, Sahajpal said.

Now, the cost is about $75,000 for treatment that lasts 12 weeks. Though it's not always covered by insurance, he said, the cost of a liver transplant down the road is greater than that of the drug.

Still, cost acts as a major barrier to treatment, Striker said.

"If insurance and Medicaid allows widespread treatment, for sure we could drive the prevalence of hepatitis C down — and possibly, within a decade or so, largely eradicate hepatitis C," he said, adding that patients need to be willing to get tested and treated, too.

Though a vaccine to prevent the transmission of hepatitis C is in its early stages and isn't expected to make a clinical appearance anytime soon, experts say the newest FDA-approved drug, Epclusa, is highly effective in treating all strains of hepatitis C.

To Sahajpal, Epclusa's approval is just another addition to the drugs introduced after 2013 that were already working well to treat infected patients.

Providing treatment services for heroin and opioid addictions, prescribing fewer opioid medications and upping the number of needle exchange and hepatitis C testing programs in the state are all part of reducing the prevalence of the disease, said Sheila Guilfoyle, the viral hepatitis prevention coordinator in the state health department's Division of Public Health.

Striker doesn't think adding Epclusa to the market will change the outlook for hepatitis C in Wisconsin as much as increased testing and insurance coverage would.

"Right now, I'm not sure that there's enough will among the health care organizations to really test everybody that needs to be tested and then pay for treatment," Striker said.

No comments:

Post a Comment