For the more than 3.2 million Americans living with hepatitis C, the cost of treatment for the chronic liver disease is an expensive proposition, costing tens of thousands of dollars. Now, however, a nonprofit says it is able to use a combo of medications for a fraction of the cost — but with the same outcome as traditional treatment.
This promising option is being developed by the Egyptian drug maker Pharco Pharmaceuticals working together with Drugs for Neglected Diseases Initiative (DNDi). The med combination uses sofosbuvir, the generic of Sovaldi, and Pharco’s experimental ravidasvir. A 12-week treatment program could run $300 in poor nations and probably a comparable price in the U.S.
The study showed cure rates of 96 percent to 97 percent even for patients with liver scarring, but researchers need to conduct more late-stage trials in order for the treatment to receive approval on a large scale in the developing world. And while the availability of this new treatment may be a few years away for U.S. hep C patients, that’s still encouraging news, says Dr. Eugene Schiff, director of the Schiff Center for Liver Diseases at the University of Miami Health System.
“What’s happening is that equally safe and cheaper generic are being manufactured in many other countries that aren’t available now in the U.S.,” Dr. Schiff says. “But there’s no question that it’s just a matter of time before we see these generics licensed [here] at a much cheaper price.”
Currently, brand name hep C drugs are made by for-profit companies such as AbbVie, Merck, Gilead, and others. Though rebates and patient assistance programs can lower the $84,000 list price of drugs like Gilead’s Sovaldi and Harvoni, they can still remain quite expensive. (The drug manufacturers do have special programs for lower-income countries, too, but they’re not available in all countries.)
Treatment is essential since there is no vaccine for hep C though there are for hepatitis A and B. In fact, “we’re not anywhere near seeing a vaccine,” Dr. Schiff adds.
Still, “there’s increasing pressure for the price of drugs to come down and I think we’re going to see that in the next two to three years.”
Hepatitis C can be blamed for almost half of the cases of liver cancer in the U.S. and is the leading cause of liver transplants. The virus, which can cause both acute and chronic hepatitis and range from a mild illness lasting a few weeks to a debilitating lifelong one, is usually spread through contact with blood from an infected person, including blood transfusions and needle sharing. Though antiviral treatment is effective 90 percent of the time, between 350,000 to 500,000 people around the world die from hep C-related complications each year, according to the World Health Organization. About 71 million people are infected with the chronic version worldwide.
Hepatitis A and B, on the other hand, are caused by different viruses. They also have different modes of transmission and can affect the liver differently. Hepatitis A, for instance, appears only as an acute disease and does not turn chronic; many of those affected improve without treatment. The hepatitis B virus can remain in the body and turn chronic, causing long-term liver problems. The most common routes of transmission are through perinatal and sexual contact as well as exposure to body fluids, such as blood and semen of an infected person.
About 80 percent of Americans infected with chronic hep C are baby boomers who likely contracted the infection during a previous blood transfusion or medical procedure when blood screening regulations were less strict. It wasn’t until 1992 that stricter blood screening guidelines were imposed. Some also injected drugs in their youth.
Though public health officials have been calling for testing among those born between 1945 and 1965, screening rates among this demographic are woefully low. A recent study, published in the American Journal of Preventive Medicine, reported that hep C testing rates increased from 12.3 percent in 2013 to 13.8 percent in 2015, a mere 1.5 percentage points — this, after the U.S. Preventive Services Task Force launched a public campaign to get boomers to take the one-time test. (Of the 76 million U.S. baby boomers, only 10.5 million had been tested by 2015.)
“Part of the problem is that many people are relatively asymptomatic,” says Dr. Schiff. Almost half of those infected have no idea they even have it. When symptoms do occur, a person may feel fatigue and fever, abdominal pain, nausea, loss of appetite, vomiting, joint pain, and have dark urine and clay-colored stool.
And if the economic and health fallout of the illness weren’t enough, healthcare professionals are noting an increase in cases, mostly due to the opioid addiction crisis that has addicts sharing infected needles when people hooked on opioids turn to injecting the drugs.
“While the boomers were the initial wave,” Dr. Schiff says, “we’re now seeing a major resurgence among young people, typically those under 25. It’s happening not just in rural areas but everywhere, in every state.”
But because they don’t fit the typical profile of a hep C patient, most are not being screened — if they go to a doctor at all. Schiff advocates point-of-care testing, testing at the time and place a patient receives care instead of waiting for the traditional testing in a medical lab that may take hours or days to retrieve results. “If they show up anywhere in the system, we need to get them tested,” he says.
He also worries that young people can be re-exposed to hep C after treatment if they continue shooting up and sharing contaminated needles.
Despite the uptick in cases among young people and the low rate of testing among baby boomers, Dr. Schiff is optimistic that hep C can be controlled and contained. He points to the World Health Assembly’s 2016 adoption of a global strategy to target viral hepatitis. It calls for eliminating viral hepatitis as a public health problem by reducing new viral hepatitis infections by 90 percent and reducing deaths due to viral hepatitis by 65 percent by 2030.
In Their Words
Ana Veciana-Suarez, Guest Contributor
Ana is a regular contributor to the University of Miami Health System. She is a renowned journalist and author, who has worked at The Miami Herald, The Miami News and The Palm Beach Post. Visit her website at anavecianasuarez.com or follow @AnaVeciana on Twitter.