On Tuesday August 4th, I attended the Update on Hepatitis C in the United States. The event took place in the US Capitol Building Visitor Center in Washington and was held by the AIDS Institute. Presentations were given by four panelists encompassing academia, government, and patient representation. The panel was moderated by Carl Schmid, Deputy Executive Director of the AIDS Institute.
The first speaker was Dr. John Ward, Director of the Division of Viral Hepatitis at the CDC. His presentation went over many of the broader issues of the public health concerns surrounding the Hepatitis C Virus (HCV). I found it striking how many parallels this disease has with HIV from a public health perspective. We have the tools to mitigate the negative effects of both, but most of the struggle lies in the implementation of these tools. Dr. Ward described a “care cascade,” similar to the one that exists for HIV; incredibly, 50% of those with HCV do not know that they have it. He also spoke about a recent epidemic of HCV transmission. Interestingly, this outbreak has occurred in primarily young, white, non-urban injection drug users. It goes to show that even with the amazing advances in Hepatitis C treatment, we still have a long way to go in eradicating the disease.
The next panelist to present was Dr. Michael Fried, Director of Hepatology at the University of North Carolina at Chapel Hill. The focus of his talk was the cost of treating HCV on a national scale, as well as the consequences of failing to address the issue. As of 2013, viral hepatitis is the seventh leading cause of death worldwide. In the US, mortality due to HCV is on the rise, and is not expected to peak until 2032. There are multiple studies detailing the drastically decreased mortality rates that accompany HCV cure treatment. In addition, curing the disease leads to significantly less adverse events, such as liver cancer and liver failure. Dr. Fried then went on to discuss the public health implications of restricted access to HCV treatment from Medicaid. This topic resonated with me, as I had recently read and presented a paper at the Forum’s Journal Club about the enormous predicted savings to the health system associated with implementing a full access HCV care system. Many states’ Medicaid programs only allow those with advanced liver disease to be eligible for cure treatment. In addition, the threshold of severity of the disease in order to be eligible varies from state to state. I was shocked to learn that in my home state of North Carolina, this threshold actually became more restrictive from 2014 to 2016. In addition, 32% of the treatment denials in North Carolina were due to this restriction. This presentation further opened my eyes to how much of medicine is a human problem rather than a scientific problem. The overall theme was summed up in a single sentence: Therapy saves lives, everyone should be treated.
The following presentation was given by Dr. John Coster, Director of the Division of Pharmacy at the Center for Medicare and Medicaid Services. It was effective in building off of Dr. Fried’s talk, going deeper into the mechanisms that determine how much people under Medicaid pay for treatment. I thought it was interesting how much states’ relationships with pharmaceutical manufacturers matter in setting prices for drugs; hundreds of thousands of people’s lives depend on those price negotiations.
The final speaker was Allen Thompson, a MedStar patient currently living with HCV. He explained that he had been living the disease since the first treatment options had become available. He spoke of the harsh side effects and severe intolerability that his body experienced with the primitive treatments. As of now, Mr. Thompson is in the latter stages of treatment and, thanks to the advances in direct-acting antivirals, has achieved a sustained virological response, which equates to a cure. I found it amazing that Mr. Thompson was able to witness with his own two eyes the staggering progress in the HCV treatment field, a testament to the perseverance of the scientific and patient communities alike, and a reminder that no one need go untreated.
