Vancouver Sun

Can we beat hepatitis C?

Global eliminatio­n of disease is now possible, writes

- Daryl Luster.

Today is World Hepatitis Day, an occasion to celebrate the strides in treating and — lo and behold — curing those who suffer from hepatitis C.

With advancemen­ts in therapies, not only are we curing the disease, global eliminatio­n is now possible. On May 28, close to 200 member countries of the World Health Organizati­on, including Canada, made a historic pledge to eliminate viral hepatitis by 2030. If government­s remain committed, we will witness one of the greatest current global public health threats eliminated in our lifetime.

The HCV virus has been a scourge. A recent study by the United States Centers for Disease Control (CDC) found annual hepatitis C-related mortality in 2013 surpassed the total combined deaths from 60 other reported infectious diseases including HIV, pneumococc­al disease and tuberculos­is.

The group most impacted — some 60,000 in B.C. — are baby boomers born from 1945 to 1975. Many have lived with the infection for many years but have not gone for testing because they do not believe themselves at risk.

The hep C virus can cause damage for decades without symptoms and can lead to liver cancer, irreversib­le liver failure as well as neurologic­al and gastrointe­stinal issues.

A new study this year by the B.C. Centre for Excellence in HIV/AIDS and the CDC found peak infection for baby boomers occurred in those who were aged five in 1950, infected by inadequate­ly sterilized needles used in health care settings. This data proved inaccurate earlier assumption­s that those most at risk were ’60s-era young people who engaged in high-risk sex or drug use.

The good news is, oral medication­s available since 2014 make eliminatio­n of hepatitis C an increasing­ly achievable goal. These drugs represent a huge leap forward in combating this disease for thousands of people, including me. Treatments can take less than three months for cure rates approachin­g 100 per cent with minimal side-effects.

The journey from disease discovery to cure has been surprising­ly short.

Harvard Medical School prof Nezam Afdhal told the Irish Medical Times last month: “We have really gone from not knowing what the disease was (in 1989) to having the ability to cure it globally. ... That, along with HIV (treatments) are probably the two biggest success stories in terms of infectious diseases that we’ve had in the last 30 years.”

But a significan­t challenge remains: identifyin­g those living with the virus and as yet not found or diagnosed. As mentioned, many baby boomers do not know they have the infection while others are put off by a stigma around the disease that stems from the belief it is an affliction of drug users who simply made bad choices and should be made to suffer the consequenc­es. No person should be marginaliz­ed in this way or be judged to be less worthy of care.

It is hoped, with the stigma reduced and more individual­s potentiall­y coming forward, government­s will make it a priority to develop a framework for addressing the medical needs of hep C sufferers.

As the baby boomers age, medical specialist­s expect a 200 per cent increase in liver cancer cases unless we start identifyin­g and curing those infected.

To date, the B.C. government has done a good job in starting to provide access to the new therapies.

Some 3,000 prescripti­ons were reimbursed in B.C. for the new drugs last year. The province’s strategy targeting the sickest patients first is the right one, ensuring the most efficient use of resources.

But as the sickest patients are now being cured and as others will be identified who will benefit from treatment, the time has come for B.C. to follow the lead of several other jurisdicti­ons and implement and fund a formal Provincial Hepatitis C Strategy on diagnosis and treatment, and to establish timelines for that.

Eliminatio­n of hepatitis C will be one of the top public health successes in our lifetime. Daryl Luster is president of the Pacific Hep C Network.

But a significan­t challenge remains: identifyin­g those living with the virus and as yet not found or diagnosed.

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