Most People with Hepatitis C Go Untreated, Despite Effective Drugs

Release Date: December 10, 2012 | By Laura Kennedy, Contributing Writer
Research Source: General Hospital Psychiatry

KEY POINTS

  • At least 4 million Americans are infected with hepatitis C, a liver-damaging virus that is often acquired through intravenous drug abuse.
  • Less than 20 percent of people with hepatitis C begin the recommended treatment regimen and less than 5 percent are successfully treated.
  • Barriers to care for people with hepatitis C include substance abuse and depression, fear of side effects and practical barriers such as a lack of transportation.
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Just 20 percent of people infected with the hepatitis C virus (HCV) begin the recommended treatment regimen and less than 5 percent go on to successfully overcome the virus, according to a new review in General Hospital Psychiatry. This is despite the availability of highly effective anti-viral drugs that clear hepatitis C virus in about 80 percent of patients participating in clinical trials. Major barriers to recommended care are substance abuse and depression in HCV patients.

Other barriers to treatment include patients’ attitudes toward treatment, including a fear of the side effects associated with some of the anti-viral drugs and an inability or unwillingness to abstain from drugs or alcohol, which is required for successful treatment.

As many as 4 million Americans have chronic hepatitis C, which is a blood-borne viral infection that is the most common cause of severe liver disease and liver transplants in the United States. In the past, hepatitis C was sometimes transmitted during medical procedures such as blood transfusions but this risk has been significantly reduced. The illicit use of injection drugs is the primary source of new infections.

People who engage in high-risk behavior in their youth often don’t realize they have HCV until they reach middle age and are diagnosed with end-stage liver disease, said Barry Hong, Ph.D., of Washington University School of Medicine in St. Louis, a coauthor of the review. Recently, the Centers for Disease Control and Prevention recommended that all baby boomers be screened for HCV.

“Screening patients with psychiatric and substance use disorders is also a must,” notes Muhamad Aly Rifai, M.D., a psychiatrist specializing in mental illness and hepatitis C at the Commonwealth Medical College in Pennsylvania.

The findings suggest that many of these barriers to care can be readily addressed through education or by treating patients’ mental conditions before or during treatment for HCV, including the use of anti-depressants, the authors suggest.

In addition to their high risk health behaviors, many HCV patients also face practical barriers to accessing treatment such as lack of transportation, good social supports, or adequate housing. The authors recommend providing a multidisciplinary treatment approach that involves social workers, physician assistants and others to provide assistance.

The review also “underscores the need for better anti-HCV regimens with fewer side effects,” notes Frederick Askari, M.D., Ph.D., a hepatologist at the University of Michigan Medical Center. “Fortunately better treatments are on the horizon, with over 20 promising compounds in various stages of clinical development.”

TERMS OF USE: This story is protected by copyright. When reproducing any material, including interview excerpts, attribution to the Health Behavior News Service, part of the Center for Advancing Health, is required. While the information provided in this news story is from the latest peer-reviewed research, it is not intended to provide medical advice or treatment recommendations. For medical questions or concerns, please consult a health care provider.

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For More Information:

Please reach the Health Behavior News Service, part of the Center for Advancing Health, at (202) 387-2829 or hbns-editor@cfah.org

General Hospital Psychiatry is a peer-reviewed research journal published bimonthly by Elsevier Inc.  For information about the journal, contact Wayne Katon, M.D., at (206) 543-7177.

North C., et al. (2012) Hepatitis c treatment and SVR: the gap between clinical trials and real-world treatment aspirations. General Hospital Psychiatry.

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Inside Healthcare   Find Good Health Care   Participate in your Treatment   Lifestyle and Prevention   Mental Health   Depression/Anxiety  



Comments on this article
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maliakkal says
December 10, 2012 at 7:41 PM

I have a few patients in my practice who are not treated for the virus inspite of being seen by Hepatologists.

Mike Bunyard says
December 12, 2012 at 1:14 PM

One of the barriers to treatment is cost. Not just the cost of treatment, which I understand could be as much as $30,000 or more, but the cost of getting through the diagnostic process that leads to treatment. Most of the people I know who have treated have had the means and the support from family and peers. While there are patients who achieve success through curremnt therapies, 80% is a very generous percentage that probably includes the very easiest to treat and ignores the many who have the most difficult to treat genotype.
my bonafides: I have HCV and I acquired it sometime in the mid 70's through injection drug use (most common route of infection). In the mid 90's I joined the oldest email listserve, hepv_l and have stayed active since joining. Lots of folks from all over the world battling this disease and relating their personal experiences. In 1996 I underwent liver transplant and in 2004 I finally managed to get clean (off drugs). From my experience, it takes a lot more than availability of drugs to treat this disease to get free. Just 2 cents frm an old guy in Oregon.