Karen Robson tested positive for hepatitis C antibodies earlier this year, but, fortunately, her immune system has eliminated the virus and she is no longer at increased risk of liver disease.Kevin Van Paassen/The Globe and Mail
A team of liver specialists joined the chorus of Canadian experts calling for a national strategy to diagnose and treat hepatitis C in Canada's baby-boomer population, in a report published Monday in the Canadian Medical Association Journal.
"Hepatitis C is clearly underdiagnosed and undertreated throughout North America," said co-author Dr. Jordan Feld, a hepatologist at the Toronto Western Hospital Liver Centre. "This is a curable infection," he added, "but most people don't know they have it."
Individuals with hepatitis C typically show no symptoms until they develop advanced liver disease – usually decades after they are infected. By that stage, Feld said, "sometimes the only option is a liver transplant."
If the virus is detected early, current treatments can cure about 60 per cent of patients diagnosed with hepatitis C. But Feld predicts that better treatments with an estimated cure rate of at least 90 per cent will be available by the end of 2014. Drug treatments are far more cost-effective than liver transplants over the long term, he added: "We're just at the cusp of having all these new therapies, so it makes sense to start treating people now."
As the Globe and Mail reported in September, an estimated one in 33 baby boomers in Canada is infected with hepatitis C. Due to high infection rates in boomers as well as immigrants, the Canadian Liver Foundation recommended in 2012 that all Canadians born between 1945 and 1975 be tested for the virus.
Despite growing evidence that thousands of Canadians may have undetected hepatitis C, the Public Health Agency of Canada's (PHAC) recommendations limit hepatitis C screening to people with risk factors such as injection drug use and immigration from high-risk countries.
According to Feld and colleagues, however, risk factor-based screening for hepatitis C has been shown in numerous studies to be a flawed approach to capturing the virus in the general population. "It's a little disappointing for us to see the PHAC sticking to this somewhat antiquated, and I would say ineffective, strategy," Feld said.
A nationwide screening program would be more expensive than risk-based screening in the short term, the authors of the CMA Journal study noted, but "it will reduce morbidity and mortality in the long-term, thereby saving future hepatitis-C-virus-related costs," they wrote.
Nevertheless, treatments for hepatitis C remain "hellish expensive," said Dr. Morris Sherman, chairman of the Canadian Liver Foundation.
The current triple-drug treatment costs about $65,000 for a complete course involving six months to a year of weekly injections. Harsh side effects include sleep problems, depression, nausea, diarrhea, muscle pain, fever, fatigue and anemia.
When patients with latent hepatitis C go into treatment, Sherman explained, "they start off well and we make them sick."
Anne Saunders, co-owner of Saunders Farm in Munster, Ont., compared her hepatitis C treatment to undergoing chemotherapy. She was diagnosed with the virus in 2006 during a routine medical exam required for a mortgage on a second home. Then 63, Saunders discovered that 75 per cent of her liver was damaged, she said. Investigators traced the source of her infection to a blood transfusion after the birth of her third child in 1967.
She was prescribed a weekly injection of interferon, an anti-viral medication, and daily oral doses of ribavirin, another anti-viral drug. Saunders said she was "out of commission" for six months, unable to help run the family farm due to the side effects of the meds, which for her included loss of appetite and extreme fatigue. "We had to hire someone to come in and cook the meals to feed the staff and family," she recalled.
The treatment was horrendous, she said, but "now I'm fine."
By contrast, Feld said, the new oral-only treatments on the horizon will have few to no side effects and will cure patients in as little as three months. Like existing treatments, the new drugs will be very expensive, he said, but still more cost-effective than transplants.
"One of the things we hope is that [the provinces] will cover the cost of these drugs," he said.
Without drug treatment, hepatitis C will run its course – and even recur after a transplant, he pointed out: "You can give a patient a new liver, but you don't actually fix the problem."