New hepatitis C drugs could completely eradicate the virus

by Nicky Pellegrino / 04 December, 2017

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A computer illustration of the destruction of a hepatitis C virus. Photo/Getty Images

For hepatitis C sufferers, new drugs could make the difference between life and death.

Hepatitis C results in more deaths worldwide than malaria, HIV or TB, but there’s good news about this blood-borne virus, which can lead to liver cancer or cirrhosis. We now have drugs to cure it, and there’s no reason we shouldn’t meet the World Health Organisation’s goal of complete elimination by 2030. We just have to get on with it, says Dr Homie Razavi.

He is the managing director of the Colorado-based Center for Disease Analysis (CDA), a public health research firm that has analysed hepatitis epidemiology in more than 100 countries, including New Zealand.

In this country, the problem seems relatively small, with about 25,000 diagnosed hepatitis C sufferers. However, it’s estimated that another 25,000 aren’t showing symptoms, so haven’t been tested. And even those who are aware they are carrying the virus can be slow to seek treatment until they become seriously ill.

Worldwide, about 71 million people are infected with hepatitis C. The main mode of infection in New Zealand was blood transfusions and medical procedures before 1992.After that, the markers of the virus were identified and the blood supply screened. The heroin epidemic of the Mr Asia years also had a big impact.

Previously, the most common treatment was interferon therapy – an expensive and drawn-out procedure with bad side effects. Now, a new generation of direct-acting anti-viral drugs offer a 90% cure rate, with few side effects and shorter treatment times. The only remaining challenge is to identify sufferers and make sure they get treatment.

Dr Homie Razavi.

This should be happening faster, says Razavi. “To me, it’s baffling. When we started working in this field, we looked at the disease and what was coming down the pipeline and thought, ‘This is a done deal, we can do this in five years.’”

Part of the problem appears to be some doctors’ reluctance to prescribe treatment for a slow-progressing illness that doesn’t necessarily result in cancer or cirrhosis and can, in some cases, be beaten by the body’s own immune system.

But it’s still a serious disease. Liver cancer is one of the leading causes of cancer deaths worldwide and is on the rise. “If this was any other cancer-causing virus, we’d have dealt with it immediately. I don’t know why hepatitis is any different,” Razavi says.

As a result of funding issues, the latest drugs are being rolled out gradually in New Zealand. Two have been available since 2016: Harvoni for those with severe liver disease and Viekira Pak for those with the most common strain of the virus. Six distinct genotypes have been identified, which means we’ve still got gaps, but Pharmac is talking to drug companies with a view to expanding treatment.

It helps that the CDA has made a financial case for investing in these drugs – with the cost at under $10,000 a person in this country. “The cost of doing nothing is substantially higher, even though not everyone develops liver cancer or cirrhosis,” says Razavi.

So far, 2000 New Zealanders have been treated with the new drugs. But that number needs to rise to about 5000 a year if the 2030 deadline is to be met. Razavi urges those who think they may have been exposed to get tested as soon as possible. More at risk are people who have had a piercing or tattoo using unsterile equipment or received medical treatment in a high-risk area such as South-east Asia or eastern Europe. Although sufferers often have no symptoms for years, unusual fatigue, joint pain, loss of appetite, nausea and abdominal pain are the most common symptoms.

“If you have the virus, there is potential for contaminating and infecting others, so if you test positive, ask for treatment,” says Razavi.

In the past, we’ve successfully controlled other once-common diseases through vaccination. “But this is completely new,” he says. “It’s the first one where we’re saying we’re going to use a curative therapy to eradicate the disease, and history isn’t going to be kind to us if we don’t do this right.”

This article was first published in the October 21, 2017 issue of the New Zealand Listener.

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