New curative treatments for hepatitis C reduce complications and the risk of dying, finds new research from the B.C. Centre for Disease Control (BCCDC).
“As hepatitis C shifts from a chronic disease to a curable illness, it is important to understand what this means for patients and the health care system,” said Dr. Mel Krajden, medical head of hepatitis at the BCCDC. “We are fortunate enough to be able to examine population outcomes and share the insights with people from around the world.”
BCCDC scientists and researchers are presenting 12 abstracts at the 2018 American Association for the Study of Liver Disease’s (AASLD) Liver Meeting
Hepatitis is a liver disease caused by different viruses. In B.C. hepatitis A is uncommon and causes a short lived infection. In contrast, hepatitis B and C can cause chronic infections that lead to serious complications such as liver failure and cancer.
The BCCDC is in a unique position to build knowledge about the disease because scientists established the BC-Hepatitis Testers Cohort
, a database that contains anonymized medical data on every person tested for hepatitis C or HIV, or diagnosed with hepatitis B, hepatitis C, HIV or active tuberculosis in the province since 1990. It also contains corresponding data on medical visits, hospitalizations, cancers, prescription drugs, and death records.
“The database offers a population-level picture of hepatitis and other infections,” said Dr. Naveed Janjua, senior scientist with the hepatitis program at the BCCDC. “This is the only province where it is possible to follow the effectiveness of interventions, programs, reinfections and evaluate prevention strategies.”
The research that has come out of this work helps inform policy and screening and treatment programs around the world.
The Liver Meeting 2018 runs November 9 to 13 in San Francisco. Here is a snapshot of some of the BCCDC research being presented:
Diabetes most costly non-liver complication of hepatitis C
Dr. Carmine Rossi, a postdoctoral fellow with the BCCDC, is presenting research that shows that people cured of hepatitis C experience a 47 per cent reduction in risk of diabetes later in life.
Dr. Rossi’s research focus is on extrahepatic illnesses, meaning conditions that are not directly related to the liver, but are seen more frequently in people with hepatitis C. Type II diabetes is one of them; it’s also the most costly non-liver complication of hepatitis C for the health care system.
While chronic infections are common, new treatments for hepatitis C, introduced in 2014, cure about 95 per cent of cases. The previous treatments only cured about 50 per cent and had bad side effects that were often worse than the disease. As a result the older treatments were only recommended for people at later stages of liver disease.
The new anti-viral treatments only require patients to take one pill per day for 8 to 12 weeks and very few people have side effects. B.C. made the decision to publicly-fund this new hepatitis C treatment for anyone infected earlier this year.
“It’s a major investment for countries to provide treatment to everyone diagnosed with hepatitis,” said Dr. Rossi. “This research is some of the first evidence that shows the economic value of treating hepatitis, especially in countries where there is a large burden of disease.”
Overdose prevention as part of hepatitis C treatment
About 230,000 people are infected with hepatitis C in Canada. Overall, people cured of hepatitis C experience a 76 per cent reduction in their risk of death.
Dr. Janjua is presenting research that shows that reducing the risk of dying doesn’t necessarily apply to everyone. He found that the reduction in liver-related mortality has only a limited impact on people who use injection drugs because they continue to be at risk of dying from an overdose or other health issues related to injection drug use.
“These findings are particularly important because B.C. is in the midst of an unprecedented overdose crisis since 2016 when fentanyl and fentanyl like-drugs began contaminating the drug supply,” he said. “We can now easily cure their hepatitis C, but also need to continue to add services to prevent opioid overdose deaths.”
Who should be screened for hepatitis B and C
People infected with hepatitis B or C may not show any symptoms for years but liver damage is still occurring. To identify those individuals before the disease causes too much liver damage, B.C. screens people who are at higher risk. Often those are individuals who use injection drugs.
Research by Mawuena Binka, a research associate working with the BC-Hepatitis Testers Cohort and a former master’s student, is trying to identify other predictors for hepatitis B or C to improve screening. In particular, she wants to identify the risk factors for people from different ethnic backgrounds because of B.C.’s large immigrant population.
By analyzing cohort data, she found that individuals who use injection drugs - regardless of ethnic group - had a higher risk of hepatitis C infection or more than one infection such as hepatitis C and HIV or hepatitis B and C. Substance use, however, was uncommon among East and South Asians affected by hepatitis B, C or HIV. For South Asians, socioeconomic marginalization was the strongest predictor of most infections.
“The characteristics of at-risk populations in B.C. vary by ethnicity,” said Binka. “These differences should be considered when developing screening criteria and prevention measures within the province to ensure broad coverage and increase effectiveness.”