Eradication of Hepatitis C Dependent on Drug Users' Access to Treatment

At the 5^th annual International Symposium on Hepatitis Care in Substance Users, experts spoke out strongly on the need for hepatitis C treatment to be more accessible to drug users.

“To delay further is unethical and undermines public health,” said Jason Grebely, of the Kirby Institute of Australia’s University of New South Wales, in a press release from the meeting.

The condition impacts as many as 100 million people worldwide, astronomically increases patients’ risks for cirrhosis and liver cancer, and kills almost three-quarters of a million people annually. The vast majority of new cases, at least in high-income nations, are among intravenous drug users.

The meeting was hosted by the International Network for Hepatitis C in Substance Users (INHSU), and the group points to economic and pseudo-scientific barriers that keep drug-using hepatitis sufferers from receiving new, effective treatments, including an assumption that illicit drug use reduced the efficacy of certain medications. The group emphasized last year’s C-EDGE CO-STAR Clinical Trial, which found no negative impact on therapy, and that reinfection rates among users were as low as 4%.

As new treatments have proven their effectiveness, organizations and countries have created audacious goals for the total eradication of the condition. The World Health Organization aspires to see hepatitis B and C eliminated as a “global health threat” by 2030, with 80% overall diagnosis and 65% treatment. Only a minority of global HCV cases are currently believed to be diagnosed.

Among a handful of countries that have set out to fight the disease directly, Australia has seen success with its recent subsidization of the most effective treatments, which include Harvoni (ledipasvir and sofosbuvir) and Daklinza (daclatasvir). More than 20,000 people have begun treatment in the first 4 months of cheap availability, a take-up rate that experts there say “would result in more people being treated in 10 months than would have been treated in 20 years of the old therapies.” With a healthcare card, these medications can cost as little as $10 per month in Australia.

In their declaration, the INHSU cites studies indicating that a 3-to-5-fold uptick in treatment amongst injectable drug users in countries like Canada could cut HCV prevalence in half there in just a decade. They praise the countries that have begun making the treatments more accessible, and call on countries like the United States to follow suit.

Currently, 12-week treatments of effective drugs like sofosbuvir can cost tens of thousands of dollars in the United States. For most HCV-positive users of illicit narcotics, those costs are extremely prohibitive. In contrast, countries like Mongolia and Egypt have found ways to make them available for as little as $900.

The costs, combined with physicians’ reticence to prescribe the treatments to drug users based on false assumptions of hindered efficacy or inevitable reinfection, stand in the way of what the WHO and INHSU believe could be a rapid eradication of the condition.

"We strongly recommend that all restrictions on access to new hepatitis C treatments based on drug or alcohol use or opioid substitution treatment be removed,” says Professor Olav Dalgard, who chaired the 2016 Symposium. “There is no good ethical or health based evidence for such discriminations. Nor do the restrictions make clinical, public health or health economic sense."

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