As deaths from many communicable diseases continue to decline globally, deaths caused by viral hepatitis have now surpassed all other chronic infectious diseases, including HIV/AIDS, malaria and tuberculosis. Yet it is one of the few global health threats with easy solutions. Highly effective vaccines exist for hepatitis A and B. We now have a cure for hepatitis C. With these tools at our disposal, why aren’t we seeing an impact on the epidemic?
The last seven years have seen a whirlwind of hepatitis C virus (HCV) drug development. Each new treatment is generally more potent than the last. The latest treatments approved for HCV in Canada this week include Maviret (made by AbbVie) and Vosevi (made by Gilead). Clinical trials of these treatments, which people take in pill form, resulted in high rates of cure (usually greater than 95 per cent) with few serious side effects. Although it will be six months or more before these drugs ascend to provincial, territorial and other formularies, their approval signals that the end of drug development for HCV is in sight.
Every year on July 28, we mark World Hepatitis Day with an event to educate, gather together, and also remember those we have lost from the hepatitis C community. This year, we should have much to celebrate: in early 2017, medications that had previously been unavailable were finally added to some formularies, including Ontario’s. This means that people with certain types of hepatitis C who have been waiting years to access safe, effective medication will finally be able to start treatment and be cured. For many, being cured means avoiding potentially fatal outcomes like liver failure and liver cancer. It also means shedding the burden of carrying a highly stigmatized illness that is often met with ignorance, ostracism and discrimination.
The hepatitis C virus (HCV) is a major public health problem. Worldwide, about 70 million people are living with hepatitis C virus infection, with a higher prevalence in developing countries. In Canada, 210,753 to 461,517 people are infected with HCV, and an estimated 20 to 40 per cent of infections remain undiagnosed. Those born during the period of 1945 until 1965 have the highest rates of infection and, having acquired the virus decades ago, are now increasingly being diagnosed with serious liver-related illnesses, including liver failure and liver cancer and non-liver related illnesses such as cardiovascular disease, diabetes and kidney disease.
Early this year, British Columbia, Alberta, Saskatchewan, Quebec and Ontario announced the lowering of eligibility requirements for access to public coverage for life-changing hepatitis C drugs, including Epclusa, Zepatier, daclatasvir and asunaprevir. These drugs will be available to those with lower fibrosis scores for the first time (the greater the fibrosis score, the more severe the liver scarring, or cirrhosis, caused by disease.)[i]
The CATIE Blog hosts the views and opinions of people and organizations working and volunteering in Canada’s response to HIV and hepatitis C.