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We Can Cure HCV
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Jules Levin, NATAP
Last week the Institute of Medicine issued a report putting forth a National Strategy for HCV, the link to the report is immediately below. Just below the link is another link to a report on the consequences of HCV in terms of epidemiology, costs, health, and death. The affect of HCV in African-Americans and marginalized patients populations is unique and has a major impact. It's estimated about 4 million people have HCV in the USA. 3.5% of African-Americans have HCV compared with 1.6% of Caucasians. 1 in 7 Black men between 41-59 yrs old have HCV. The Response rate to the current standard of care therapy, peginterferon+ribavirin is very low for African-Americans. On average for the most difficult-to-treat patients, the SVR or 'cure' rate is about 40-50%, (these are patients with genotype 1 as opposed to genotype 2 where response rates are much higher) but for African-Americans the SVR rates range from 5-25%. There are 2 very relevant reasons for the low response rates: 1- there appears to be a genetic difference between whites & blacks in their innate ability to respond to interferon, which is an immune-based therapy, 2- many of these studies with very low response rates are conducted at urban inner city clinics where patients have a history of illicit drug. There are 20 new anti-viral orally administered drugs in development now which differ from the current therapy in that they do not depend on stimulating the immune system to respond to interferon. Response to these anti-virals is expected to be similar for all. I expect that over the coming 9 years as these drugs roll out and we put together multi-drug combination therapies the 'cure' or SVR rates will be steadily increasing towards 90 or even 100% in the USA for all patient groups. The new drugs will also shorten duration of therapy to 6 months in the future. Of note, HCV is a curable disease so with 6 months of successful therapy the virus is gone and the patient will not have to address HCV again. This presents a unique situation unlike other diseases, we are presented with the opportunity now to cure a disease. Federal support is needed to help accomplish this: funding for programs for testing/screening, linkages to care & education, and support services for patients is needed to accomplish this very reachable goal. 75% of the 4 million people with HCV in the USA are undiagnosed, which is why we need a major testing/screening program to raise awareness to get people tested. Then we need linkages to care to bring people into care. Of the 4 million with HCV in the USA 25% already have cirrhosis, which means we are under a time constraint to get HCV-infected people tested and into care before they start getting liver cancer and dying. The opportunity to cure this disease has a sunset. Once individuals start getting sick the economic consequences and costs related to HCV start increasing quite signifcantly, so we can avoid many of these consequences if we launch a Federally funded program now.
Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C - Report from the Institute of Medicine (IOM) pdf of full report attached - (01/12/10)
Consequences of Hepatitis C Virus (HCV): Costs of a Baby Boomer ...
Link to Millman Report: http://www.vrtx.com/millimanreport.html lso as an FYI - the Milliman site is also up and running now with both a link to the full ...
www.natap.org/2009/HCV/051809_01.htm
From Baby Booming to Hepatitis C
Baby Boomers well past their wild years are now facing the consequences
Quetzalli Castro
http://media.www.chicagoflame.com
Despite affecting 1 percent of the population, hepatitis C remains a disease generally misunderstood by the general public with little in financial commitments from the federal government. The CDC's National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention had a budget of almost $1 billion for 2008. Only 2 percent of that was allocated to hepatitis B and hepatitis C despite both viruses being five times more prevalent than the rest. According to the CDC Hepatitis C virus (HCV) infection is the most common chronic bloodborne infection in the United States.
Now, a newly-published Institute of Medicine Report on hepatitis B and C underscores how this lack of understanding and attention has played out. Although the risk factors for hepatitis C are widely known and completely preventable, the Institute of Medicine (IOxM) estimates that between 2.7 million and 3.9 million Americans have contracted HCV.
This number in itself is worrying but the most startling statistic about HCV is not its prevalence, but the population it affects. The reports indicate that two-thirds of those infected with the virus are Baby Boomers. For some, Woodstock is a distant memory from their youth where they may have experimented with intravenous drugs. Now they are adults in their 50s or 60s and HCV, which is transferred by contact with infected blood, has a particularly long incubation period, often 20 or 30 years. That means that the side effects of one drug use in the 1970s could start to show up in the next couple of years.
A large part of the problem with curbing HCV's prevalence is that most of these persons are chronically infected and might not be aware of their infection because they are not clinically ill. Infected persons serve as a source of transmission to others and are at risk for chronic liver disease or other HCV-related chronic diseases during the first two or more decades following initial infection. In reality, population-based studies indicate that 40% of chronic liver disease is HCV-related, resulting in an estimated 8,000-10,000 deaths each year (CDC, unpublished data). Furthermore, HCV-associated end-stage liver disease is the most frequent indication for liver transplantation among adults.
The research indicates that right now is a particularly critical point in time for early detection and treatment of hepatitis C, particularly among the Boomer population. The test for HCV can be easily administered, and the CDC and IOM have the risk largely pooled in a specific demographic, why do so many cases go decades undiagnosed? Doctors say it has a lot do with the stigma surrounding liver disease. When someone is diagnosed with cirrhosis of the liver, a person is more likely to be blamed for abusing alcohol among other things before being seen as an HCV infected person. This alone can prevent many from coming forward with their concerns.
At the moment both the IOM and CDC want to change that. The IOM report recommends a comprehensive public education and surveillance campaign, to increase awareness of the disease, following the model of HIV/AIDs public awareness campaigns in the 1990s. All in all, HCV is now a serious challenge for both doctors and public health officials, largely because of its long incubation period and because of this and the stigma that surrounds it, we may be seeing the next biggest campaign for cause since HIV/AIDs.
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