Hepatitis C: A Growing Threat, and a Missed Opportunity

Today's Managing Health Care Costs Indicator is 3.2 million

Imagine that there is an infection which can be detected through screening.   There is an effective but expensive treatment, and many of those who suffer from the disease will die prematurely without detection and treatment.  Further, imagine that those who don’t know they have the disease will transmit the infection through sex or through shared needles – leading to preventable deaths and disabilities of hundreds of thousands more. 

This sounds like South Africa under Thabo Mbeke in the late 1990s  - where the government denied that HIV was the cause of AIDS, and refused to fund screening or treatment.  Researchers believe that 365,000 died due to the inaction of the South African government.

An article in JAMA last month reminds me that we don’t have to look very far to see a similar avoidable tragedy unfolding.   

In the United States, Hepatis C is a scourge.   About three quarters of those infected get chronic hepatitis.  Two thirds of these have active liver disease and a quarter of those get cirrhosis. The viral infection causes liver cancer, and is the largest cause of liver failure (and transplantation) in the US.    There is no vaccine, but a handful of (expensive) antiviral medications have recently been shown to be effective in lowering viral count, reducing new infections. There are recent reports that antiviral therapy has led to actual cures – a result we still haven’t achieved with highly active antiretroviral therapy for HIV infection. 

There are 3.2 million Americans with Hepatitis C – and most of them (66-75%) don’t know they have it.  About a million of those with Hepatitis C  pass through the US correctional system each year – so we could diagnose many of these cases through voluntary testing.  We could also treat newly-found cases of Hepatitis C – which could prevent future liver failure and prevent infection of others. It wouldn’t be easy, of course. The current drugs cost $30-60,000 for a 12 week course of treatment – it’s hard to imagine coming up with that kind of money in the prison system.   Just like high drug prices make it hard to imagine South Africa treating all of its HIV-infected individuals with expensive HIV drugs in the days before generics were available.  

We should  start diagnosing and treating prisoners who have Hepatitis C.   We also need to negotiate aggressively with the pharmaceutical industry to lower the prices of these lifesaving medications when they are purchased in bulk.  Hepatitis C killed more Americans than HIV last year!   We should not stand by and watch a public health failure like that of South Africa in the late 1990s.