iIn 2005, Nick Voyles was diagnosed with hepatitis C after being released from five years in prison. A nurse told him he had only six months to live. He was prescribed a drug cocktail, a combination of interferon and ribavirin, which did not work and caused him serious side effects. “It tore me apart — the whole treatment was killing me,” recalls Voyles, who lives in Bloomington, Ind. lives, himself.
Voyles’ experience highlights the challenges patients faced when doctors prescribed hepatitis C drugs that proved unsuccessful in treating the viral infection that affects the liver. Fortunately, in his case, his symptoms subsided after several weeks and he eventually gained access to a cure.
In the past ten years, scientists have evolved new therapeutic drugs to fight hepatitis C. Simple oral direct-acting antivirals (DAAs), such as the combination drug sofosbuvir/velpatasvir, can effectively cure the highly contagious disease in just 12 weeks.
But these groundbreaking treatments aren’t getting to the people who need them, according to a Centers for Disease Control and Prevention report study released Thursday. Only one in three adults diagnosed with the disease has been cured since 2013, when those highly effective cures for hepatitis C were introduced approved first in the U.S
The drugs cost about $24,000 per course of treatment, which is a major barrier for many people infected with hepatitis C. These accessibility issues are “really disappointing,” said Francis Collins, former director of the National Institutes of Health, who is now leading a proposal program for the federally funded national elimination of hepatitis C plan in the US “I don’t think as a society we can look at that and say it’s OK – it’s not OK.”
The CDC report notes that cure rates are lowest in people without health insurance or Medicaid coverage. Among adults under 40 – the age group with the highest rates of new hepatitis C infections – only 1 in 4 people were cured. And while treatment rates were highest among people age 60 and older who were covered by Medicare or commercial insurance, less than half were still cured.
Hepatitis C experts told STAT that the disease is a public health crisis that requires a strong response.
“Hepatitis C infections are getting worse,” said Adrienne Simmons, program director of the National Viral Hepatitis Roundtable. Cases of the disease increased between 2013 and 2019, up 15%, according to the CDC. “We’re probably just seeing the tip of the iceberg.”
The cost of treatments isn’t the only barrier people face with the infection. In the US, diagnosis of hepatitis C is a complicated process.
First, a blood test, known as an antibody screen, is needed, which looks for proteins that help fight infection. If that test is positive, doctors then need a genomic test to confirm the hepatitis C virus itself.
“It’s very cumbersome,” said Anne Spaulding, an associate professor of epidemiology at Emory University in Atlanta. That means patients are delayed in getting a confirmed diagnosis and treatment. “We need to develop a one-step test and just look for the virus,” she said.
The Collins National Hepatitis C Elimination Program aims to help people get tested faster by supporting the development and adoption of rapid point-of-care viral tests for hepatitis C. that same visit,” Collins said.
This strategy, known as testing and treatment, can have a major impact, said Meg Doherty, director of global HIV, hepatitis and STI programs at the World Health Organization. “If the U.S. can do this, there may be other high-income countries that are going to do this to meet the hep C elimination goals,” she said.
About 90% of people with hepatitis according to the WHO do not know they have it. Rapid tests would not only help people access treatment more quickly, but also help curb its spread new hepatitis C infections.
The White House-backed program also aims to establish a national model for hepatitis C drug delivery that would reduce the cost of treatment by negotiating a large quantity of the drugs and selling them at a fixed price. to buy. “The cost per patient will be extremely low,” Collins said.
The White House has solicited $11 billion in funding from federal agencies to take these and other important steps toward achieving hepatitis C elimination in the U.S.
Collins told STAT the plan would prevent tens of thousands of cases of cirrhosis, end-stage liver disease and liver cancer, eventually to rescue billions in healthcare spending. “Now over the course of five years, if we can find those people who are hepatitis C positive and get them cured, we would save the government about $13.3 billion in the first 10 years.”
More than 2 million people in the US have hepatitis C, and nearly 15,000 died of the infection in the year 2020. Among the people most affected by the disease are drug users and inmates – populations that are often stigmatized and hidden from public view. A STAT study last year documented how hundreds of incarcerated people died of hepatitis C without medical care.
“About one-third of the hepatitis C epidemic is represented by individuals who spend at least part of their lives in prison or prison,” said Spaulding, who studies infectious diseases, including hepatitis C, in institutionalized populations. This makes the prisons a prime target in elimination efforts. “Without the treatment of prisoners, especially those in prisons, we will not achieve the elimination of hepatitis C in the US,” she said.
Simmons added that one of the most important aspects of the plan proposed by the White House is the push to get rid of restrictive coverage policies by some. state Medicaid programs and commercial insurance companies that exclude patients from treatment until they receive prior authorization and unless they have severe liver damage and do not use alcohol or drugs for months.
Collins said the new CDC report underlines the need for a bold, strategic response to eradicate hepatitis C. we have this unique opportunity that doesn’t come along very often,” he said. “It’s both saving money and saving lives.”