What do the homeless, prisoners, people with HIV, and millions of baby boomers have in common? They’re all susceptible to hepatitis C virus (HCV).
That’s according to gastroenterologist Luke Bi, who has practiced at Hazel Hawkins Memorial Hospital for the last five years. Bi explained that 60-plus million aging baby boomers are at the highest risk in his report at the April 25 Board of Directors meeting.
HCV infection and treatment is a hot topic in medicine, Bi said, because it has become so widespread, with more than 80 million people having contracted it. There is no vaccine available to prevent it, and it is the leading cause of liver failure and liver cancer in the United States. There are oral medications for treatment once someone has the infection.
Fewer than half of those with HCV are diagnosed because there are few symptoms before it becomes chronic, Bi said.
“There’s nothing to look for,” he said, “and you only find it if you do extensive blood tests. This is an infection that’s underdiagnosed and is a public health issue.”
He said treatments used to last from six months to a year, with cure rates, or sustained virologic response (SVR) rates, typically around 40% to 50% for the most common type of HCV. But in the last five years, there has been a revelation in treating HCV, Bi said.
“We currently have several well-tolerated, oral pill treatments for the hep C virus with cure rates close to 100%, for patients who take them for as little as eight weeks,” he said. “Those treatments are widely covered by insurance, whether it’s a commercial plan, Medi-Cal or Medicare.”
He said the Centers for Disease Control determined that all baby boomers—people born between 1946 and 1964—should be screened for HCV because 75% of HCV patients are baby boomers. The reason people born in that timespan have high rates of Hep C is not completely understood, according to the CDC. Most are believed to have become infected in the 1960s through the 1980s when transmission of HCV was highest. Before widespread screening of the blood supply began in 1992, HCV was spread through blood transfusions and organ transplants.
“That is beginning to shift because of IV drug use over the last decade or so,” Bi said. “Of the new hepatitis C infections, about 80% occur among patients who injected drugs.”
He said it doesn’t matter the makeup of the community, whether city or rural, it is a common infection.
“It’s not going away,” he said. “We’ll probably see it more and more in our hospital setting, as well. The characteristic about hep C that makes it really concerning is that 75% to 85% of those exposed to it will develop a chronic infection, especially if they were exposed in early adolescence or adulthood. About 20% of those will develop cirrhosis, and 30% of those their livers will start to fail, which can lead to liver cancer.”
Hospital board member Ariel Hurtado asked if people were even aware that they might have a chronic infection. Bi said many are not.
“That’s why the CDC recommends we do routine screenings, regardless of symptoms,” Bi said.
He called HCV the “low-hanging fruit” of illnesses because it’s so treatable.
“Starting around 2013, they started having direct antiviral agents that hiked the cure rates up to 60% to 70%,” Bi said. “Most recently, we have had oral antiviral agents with very few side effects that produce close to 100% cure rate. This can now be easily cured if the patients are screened early.”
Hazel Hawkins CEO Ken Underwood asked Bi how much the medications cost. Bi said there are currently three: Epclusa, Daklinza and Mavyret. He said, initially, the cost was $100,000 for treatment, but competition has brought it down. The wholesale price of Mavyret is now around $26,000 for treatment, Bi said, adding that Epclusa just went generic and costs about $24,000.
“The treatment is widely covered, and the two big companies that are manufacturing it have programs that help provide medication free of charge for patients who don’t have insurance,” Bi said.
Underwood told BenitoLink there are discussions about setting up an HCV screening program in San Benito County.