Initiative seeks to treat hepatitis C in Alberta HIV patients

A long-term effort to eliminate hepatitis C as a public health threat is underway in Alberta, where a new program aims to provide medications to one particularly vulnerable group of patients.

Dr. Stephen Shafran, an infectious disease expert at the University of Alberta, said his new initiative is reaching out to Albertans with hepatitis C who also have HIV infections.

Such patients are a priority since the presence of HIV has been shown to accelerate the progression of the other disease, increasing the chances of severe liver damage, Shafran said.

As well, he said some patients from the group are known to engage in risky behaviour, including the sharing of needles and other drug paraphernalia, the easiest way for hepatitis C to spread.

“So if we eliminate their Hep C, they can’t transmit it,” he said.

Shafran said the Northern Alberta HIV Program has a roster of 2,300 patients, about 20 per cent of whom have also been diagnosed with hepatitis C.

Over the past year, staff have treated a number of those patients from Edmonton and the northern part of the province, but there are still 220 to 240 people on the list who have proven harder to reach for a number of reasons.

The goal of the initiative is to treat 90 per cent by the end of 2018, Shafran said.

“Some of our hardest-to-reach patients are struggling with various addictions and have a propensity to miss appointments, they are in and out of remand and stuff like that, so we recognized we weren’t going to reach them with a passive program,” he said. “We’ve realized we have to try as best as possible to adapt the program to the patient rather than have the patient adapt to the program.”

In some cases, this could mean patients who are already going to a pharmacy for regular doses of methadone or Suboxone could receive their hepatitis C drugs at the same time. In other cases, the Edmonton Remand Centre and various inner city agencies could be employed to help ensure patients take the medication.

As many as 250,000 Canadians are estimated to have hepatitis C, though many don’t know it because years can pass before symptoms of liver disease are noticed.

No vaccine exists, but medications developed in recent years have been shown to cure at least 95 per cent of patients in 12 weeks or less, Shafran said.

Funding for the initiative is being provided through a grant from Gilead Canada. The pharmaceutical company makes one of the hepatitis C treatments, though Shafran said the program is free to use drugs made by other companies.

After tackling the population within the HIV community, the effort to eliminate hepatitis C will have to focus on other groups, he said. A good place to start would be to track down anyone who has tested positive for hepatitis C in the past to find out whether they have received treatment, he said.

Other experts have advocated for widespread screening of baby boomers, since that generation was subject to blood transfusions that relied on unsafe blood.

The Canadian list price for hepatitis C drugs is hovering around $60,000 for a course of medication, though it’s believed the provinces negotiated an undisclosed reduction that allowed them to increase access to more people, Shafran said.

In Alberta, coverage has been expanded as of April 1 to include all patients with hepatitis C. Previously, coverage was provided only to patients at an advanced stage of the disease or those with complications.