Francesca Tomasi received her B.A. from the University of Chicago and is now a microbiologist.
Hepatitis C (HCV) is a virus that primarily affects the liver. Though it is generally asymptomatic, chronic infection can lead to liver failure, liver cancer, or other life-threatening conditions that typically require a liver transplant. HCV is spread by blood to blood contact, which occurs most frequently through intravenous drug use, poorly sterilized medical equipment, and blood transfusions. Since its emergence, the virus spread silently and went virtually unnoticed. No one was on the lookout for it because nobody knew it existed. After blood transfusions became regular medical practice, however, doctors eventually noticed a rise in liver disease and set out to find the culprit. HCV was identified in 1989.
The isolation of a virus and identification of its cause prompt public health officials to introduce preventive measures. When HCV appeared on the public health radar, clinics began screening blood collected for transfusions, and hospitals in developed countries made sure to sterilize any re-usable needles. However, transmission of HCV still persists today as a result of sharing needles for intravenous drug use (IVDU), sexual intercourse, and accidental contact with infected blood by health care workers. Because of the associations between drug abuse, poor sanitation, and HCV, the disease carries a stigma with it; and while millions of individuals in the United States alone are infected, most do not know it. Those who are at the highest risk are the least likely to present themselves for screening, and people who unknowingly acquired the infection as children do not learn that they have it until they develop symptoms of liver damage later in life.
For a long time, standard treatment for HCV required 48 weeks of weekly interferon injections coupled with oral antiviral pills. Unsurprisingly from such long-term treatments, side effects were the norm, and many people either stopped or refused treatment to avoid fatigue, depression, irritability, and other debilitating conditions. Everything changed in 2013 – or at least, it should have. Two drugs, sofosbuvir (Sovaldi) and simeprevir (Olysio) were FDA approved to treat 3 different types of HCV. The new treatment regimens produce drastic reduction of viral load in just days and have minimal side effects. Last May, the World Health Organization in fact added 5 new HCV drugs on its list of essential medicines. For the first time since it appeared, Hepatitis C could be successfully treated with little to no malaise. But there was a new side effect: some of the treatments cost over $1,000 per pill. Sovaldi, for instance, costs at least $84,000 per regimen in the United States. In February, Gilead Sciences reported that Sovaldi was one of the best-selling drugs in the world in its first year on the market. To compensate for its cost in lower income countries that would otherwise be unable to afford Sovaldi, Gilead has allowed multiple manufacturers to synthesize their product as a generic drug; in India, for instance, eleven generic drug makers produce the drug and sell it in over 90 developing countries (giving Gilead 7% in royalties). Middle-income countries, however, are feeling the strain where generic manufacturers are not authorized to sell Sovaldi. Last May, activists in Argentina, Brazil, China, Ukraine, and Russia demanded voiding the drug’s patent: as officially-recognized developed nations, they do not qualify for purchase of the generic form of the drug. In those 5 countries alone, it would cost over $200 billion to treat over 40 million people with HCV. Sovaldi is financially out of reach for millions of people.
The virus is also on the rise in the United States and its cure unattainable by many. Last May, for instance, the CDC announced a rise in cases in Appalachia. In Kentucky, hepatitis C rates are 7-fold the national average, and these statistics are based only on confirmed cases of the virus, which the CDC estimates account for about 10% of all cases in the country. And since HCV is afflicting more and more young people in America from IVDU and infections passed on from the baby boomer generation, fewer patients are qualified for treatment for a disease that doesn’t cause symptoms until older age. State Medicaid programs only authorize Sovaldi when HCV has progressed to an advanced stage, despite the Infectious Disease Society of America’s recommendation that all diagnosed individuals be qualified for treatment funding.
Thousands of miles away from the Medicaid debates in the United States, a nation in Africa is suffering the aftermath of a decades-long campaign to eliminate the threat of schistosomiasis, a parasitic illness spread by water snails. The campaign succeeded – the disease became less of a threat to the people of Egypt – but it left the country with a potentially bigger problem: hepatitis C spread like wildfire when nurses did not sterilize the needles they used for schistosomiasis vaccines every time they jabbed someone. It is now estimated that about 10% of Egyptians have HCV, the highest rate of infection in the world. Read the New York Times’ recent piece on the fight against hepatitis C in Egypt here to learn more about how the country is battling the disease and its expensive treatment: http://www.nytimes.com/2015/12/16/health/hepatitis-c-treatment-egypt.html?ref=health.
In a world of increasing life expectancies, diseases that take their toll later in life like hepatitis are increasingly important to treat. As we have seen, a huge medical hurdle was cleared a couple of years ago: HCV is now curable, and treatment no longer requires months of nagging side effects. The current financial hurdle is just the next step in Earth’s war on deadly infectious diseases.