When provinces in Canada lifted restrictions pegging eligibility for treatment for hepatitis C with direct-acting antivirals to the stage of the disease — or range of liver damage — to make the medicines universally accessible, the numbers of people who accessed the treatment nearly doubled, a study reported in Clinical Infectious Diseases found. New initiation of treatment to clear the virus, arrest liver damage, and stop ongoing transmission of the virus peaked in 2016 at 25% of those in the groups studied beginning treatment, before dropping, by last year to 17%. Still, even that rate, if sustained, would make possible stopping the spread of the virus among people living with HIV in Canada the authors write. The data has potential international implications for steps needed to achieve World Health Organization goal of eliminating hepatitis C globally by 2030, the authors, led by Sahar Saeed of the Research Institute of McGill University Health Centre, note.
While hepatitis C is seen as on track to surpass HIV, tuberculosis and malaria as a leading infectious disease killer, drugs developed in the last year that clear the virus in as little as 12 weeks have made goals of eliminating, even eradicating the spread of the virus conceivable. At the same time, prohibitively high prices for the drug have led to restrictions, based on the amount of damage already done by the virus, on when it is prescribed and used. These restrictions tend to make people who are older, and have had the virus for longer, and been made sicker by it, more frequently eligible than younger, healthier, more active people at greater risk of transmitting the virus through injecting drug use or sex. Countries with elimination of the virus by 2030 in their sights have two things in common, the authors note: unrestricted access to the medicines, and at least 7% of those infected initiating treatment each year.
The lifting of restrictions across three provinces in Canada allowed researchers to glean results of what they call “a natural experiment” occurring in a country where access to health services is universal, but where access to medicines has been skewed by pricing. They narrowed their focus on people who were co-infected with HIV, and who had injected drugs in the preceding six months — an exposure that accounts for as many as 80% of hepatitis C infections among people living with HIV. The authors surmise that the numbers of those initiating treatment dropped after the first years that treatment eligibility restrictions were lifted because doctors had longer lists at that point of patients who needed the medicine and who could now get it.
The authors caution, however that additional significant barriers, including limited access to harm reduction services — that can facilitate treatment initiation and prevent reinfection — stand in the way of treatment access for the most marginalized populations.