Since HEPATITIS C was discovered in 1989, the pharmacological management of infections caused by the virus has undergone some revolutionary changes, significantly improving cure rates and reducing patient morbidity and mortality. Previously people diagnosed with hepatitis C would be faced with 24-48 weeks of treatment that was, at best, difficult for most patients to complete and, at worst, impossible to complete for others.
The treatment combined two drugs interferon and ribavirin, which were accompanied by a laundry list of side effects so significant that counselling of patients’ loved ones was often necessary.
There is still no vaccine for hepatitis C and people can contract hep C more than once. According to Health Canada, it’s estimated that 170 million individuals are infected worldwide, including about 250,000 Canadians. Hepatitis C is spread through contact with infected blood.
Patients with mental illness were not offered treatment due to the possibility that treatment could actually worsen their mental illness. Generally, patients who did receive treatment suffered through physical and emotional side effects despite knowing that the successful cure rate was just 40-60%. Now, fast forward to present day, and advancements in treatment for hep C patients allow for a much more positive outlook in their battle against the disease, with new hepatitis treatments curing 90-95% of patients.
In 2011 the first direct-acting antiviral agents were introduced and since have continued to improve both the efficacy and tolerability of treatment. The development of the direct-acting antiviral agents has reduced disease burden, expanded treatment options for patients with different hepatitis C genotypes or other pre-existing comorbidities, and significantly improved cure rates, which now exceed 95% with newer antiviral agents.
Barriers to using this therapy in British Columbia include suboptimal population screening and diagnosis, variable patient and physician knowledge, high drug costs, lack of insurance coverage for some antivirals, and difficulty accessing coverage under Pharmacare. Re-infection is also an ever-present risk. Using the antiviral therapies currently available and ensuring patients have better access to care would make eliminating hepatitis C possible in British Columbia, especially if health care providers, patient communities, and government agencies all strive to achieve this goal.
