Hepatitis C cases on the rise in Florida
Local physician providing free care and medication to treat poor and uninsured
Dr. Philip Styne was a volunteer physician in 2017 at the Shepherd’s Hope free clinic in Longwood when he noticed quite a few patients with hepatitis C.
So he started a weekly clinic, providing free care and medication to poor and uninsured patients who had the infection. He has since cured about 100 hepatitis C cases.
It’s an effort to make a dent in a liver infection that can be deadly if left untreated and costly to treat.
“The point is that these people really suffer, and they’re very expensive to take care of. So if we can eliminate hepatitis C, we can make people healthier and eliminate long-term costs,” said Styne.
Styne backs up his concern with studies and data that show a steady rise in the rates of hepatitis C infection across the nation and Florida.
The new cases of hepatitis C — called acute hepatitis C by medical professionals — have been increasing across Florida, from 105 cases in 2010 to 484 cases in 2018. So far this year, more 680 cases have been reported by the Florida Department of Health, surpassing last year’s total.
Data shows that the new hepatitis C diagnoses are mainly associated with drug use and needle sharing, and the ongoing opioid epidemic has been fueling the spread of the disease.
Better access to treatment and recovery services for addiction have been shown to help reduce the infection rates. Needle exchange programs can also reduce the spread of injection-related infectious diseases.
Although Florida passed a bill this year to authorize a needle exchange, Central Florida counties have not yet implemented a program.
Acute hepatitis C cases, which means being infected with the virus for less than six months, can turn into long-term infections, better known as chronic hepatitis C.
While about 25% of infected individuals clear the virus, in 75% to 80% of the cases, the virus turns into a chronic disease, slowly and silently damaging the liver until patients start showing
symptoms.
In Florida, the rates of acute and chronic hepatitis C, which take into account population growth, have increased during the past decade.
Patients with hepatitis C “are at risk of developing liver cancer and liver failure. And while they’re infected, they can be transmitting to others without knowing it. So it’s a major health problem in the U.S.,” said Susan Borgiasz, a nurse practitioner at Turning Points in Bradenton, which has been running a free hepatitis C clinic for three years.
Hepatitis C is spread by direct blood to blood contact, which can happen by sharing dirty needles, especially among injection-drug users; during sex, especially among men who have sex with men; or sharing personal hygiene items like razors and toothbrushes. The virus can be transmitted via dried blood.
Unlike hepatitis A, there’s no vaccine for hepatitis C. But there’s effective treatment for it.
The hepatitis C virus was identified in the 1980s. The initial treatments involved shots and pills for a year, which made people feel like they had the flu and only about half of the patients got cured.
But over the years, more effective medications were developed that cause very few side effects. The cure rate for today’s hepatitis C drugs, which are taken by mouth daily for eight to 12 weeks, is 95%.
Styne believes that some primary care doctors may shy away from treating patients with hepatitis C because they think the treatments are still complicated and ineffective, so as part of his outreach he talks to them about new medications that have been available in the market since 2013.
“What we’re doing really is trying to educate [physicians] and provide them with backup if they have somebody who’s complicated,” said Styne, who has been a practicing gastroenterologist in Orlando for 37 years.
Baby boomers — born between 1946 and 1965 — are at a high risk of hepatitis C infection. They are six times more likely to be diagnosed with hepatitis C than other age groups, partly because of unsafe medical practices in those years.
Veterans are another group at risk of hepatitis C, almost three times more likely to be infected with the virus than the general population, likely due to having higher risk of exposure to blood during battle.
Meanwhile, adults between the ages of 20 to 29 carry the burden of new infections in recent years, data shows. New cases of hepatitis C increased by about three-fold between 2010 and 2015, according to the CDC. The agency attributed the increase mostly to the rising rates of injectiondrug use.
The Orlando VA, which has been running a robust hepatitis C treatment program, gets about 250 new hepatitis C infection each year, with the average age of 30 years old, said Karen Slazinski, a clinical pharmacist at the Orlando VA.
About five years ago, the Orlando VA was identified to have one of the largest number of hepatitis C populations in the VA system. In response, local officials asked for additional funding to start treating the sickest patients to cover the cost of the medications, which has a general price of $1,000 a day.
“In our region, we created a dashboard so that we could find all of these patients and sort them by the sickest patients first,” Slazinski said. “Then our infectious disease department started calling patients” and scheduling them for appointments, she said.
The department created a one-stop shop for patients, so that they could see the infectious disease doctors, get their tests and talk to a clinical pharmacist to start the treatment. A pharmacist and nurse practitioner were responsible for the majority of the follow-up visits, monitoring and medication renewal. Social workers played an instrumental role in getting patients scheduled for their visits.
The team also worked hard to coordinate care for patients who were homeless or didn’t have transportation.
“We’ve now treated 2,300 out of our 2,500 hepatitis C patients,” said Slazinski. “We’re also proud that of those treated, we have a 97% cure rate.”
Treating hepatitis C doesn’t create immunity from the infection.
At Orlando VA, 21 of the 2,300 treated cured patients were reinfected with the virus.
“We feel like we’re doing our part to get everybody cured of hepatitis C so that our guys aren’t giving it anyone else, but then I guess our guys are catching it from someone else,” said Slazinski.
Meanwhile, Styne has recruited three primary care providers to help him run the clinic every week on Tuesday mornings. The clinic, which also treats patients with hepatitis A and B, accepts patients who earn less than 200% of the federal poverty level. To make an appointment, call 407-876-6699.