A New Frontier For Hepatitis C

If you have Hepatitis C, or treat patients with the virus, everything is about to change . And maybe it already has.

First, new drugs are available now, and more are coming this fall, that will revolutionize the way we treat - and cure - the disease. That word, "revolutionize," isn't mine. It's what I've heard over and over from doctors who say the new direct acting anti-viral (DAAs) drugs, which directly target the Hep C  virus, take only 12 weeks, have a high cure rate, and cause few side effects. They're lightyears, doctors tell me, beyond the drugs they were using to treat the disease just six months ago. The main drug, interferon, was a nightmare for many patients. And it's about to become obsolete.

But the new DAAs are expensive, $1000 a pill. A 12-week course of treatment is $84,000. Insurance companies and public payors like Medicaid are just beginning to wrap their heads around the new reality. They're coming up with policies that will determine who gets the new drugs, who's not a "candidate," and who has to wait. But time isn't your friend if you have Hep C.

Hepatitis C is a virus that spreads through infected blood. If you used IV drugs, even if you didn't share a needle but shared other paraphernalia, you could have picked it up. If you received a blood transfusion before 1992, when we began testing the blood supply for the disease, you could have been exposed. Not everyone who's exposed develops the disease. But a majority do. The thing is, it takes decades before symptoms are noticeable. Meanwhile, the virus attacks the liver. And with no treatment, it progresses to liver disease, including cancer and cirrhosis.

Who's showing up with chronic Hep C now? Baby boomers. Most don't know they have it.

In fact, boomers are five times more likely than any other group to have Hepatitis C, and the signs of their chronic infections are just starting to emerge. A doctor who treats patients with the disease both in and out of prison told me the other day that we're standing on the shore now, unaware that a "tsunami" of chronic Hep C is about to crash over us. And no one knows quite yet how many new infections are developing because of the resurgence of IV heroin use among people who initially got hooked on prescription opioids, like OxyContin.

One more complicating factor: the disease is more prevalent among the incarcerated and IV drug users, people who already face stigma and lack a strong connection with the health care system. Who's going to want to spend $84,000 to cure someone who might just go out and get reinfected, advocates worry.

Tiny Rhode Island has a higher prevalence of Hep C than the national average. But its small size just might make it the ideal place to try some innovative approaches to tackling the disease. For my fellowship project, I'm planning series of radio documentaries about the challenges of finding people with the infection, treating them, and getting that treatment paid for. From the state prison to the Veterans Affairs hospital to treatment centers for IV drug users, new efforts are underway to screen people at risk. But it's not at all clear yet how these institutions will cover the cost of treatment.