By: Marcus J. Hopkins, Policy Consultant
A study published in Clinical Infectious Diseases has found that restricting access to Hepatitis C (HCV) Direct-Acting Antivirals (DAAs) may decrease survival rates among people co-infected with HIV (Breskin, et al., 2019). These findings comport with similar findings published in 2017 that found co-infection with both Hepatitis B (HBV) and HCV in HIV patients is significantly associated with increased all-cause and liver-related mortality rates (Thornton, et al, 2017).
[On the cover: There they go, plucked, etching, burnished aquatint and drypoint, 1797–98, by Francisco de Goya (Spanish, 1746–1828). National Gallery of Art, Washington, D.C. Art Resource, New York, NY. Reproduced with permission. Like several prints from Los Caprichos (caprices), this image refers to a pun: the Spanish word desplumar, “to pluck”, has the same connotation as “to fleece” in English. These prostitutes are shooing out customers they have fleeced, to make room for new ones. Their bald customers, in a further play on desplumar, may also mean that they were suffering from syphilis, associated with hair loss, for syphilis was a common disease contracted from prostitutes. (Mary & Michael Grizzard, Cover Art Editors)]
Essentially, people living with HIV who are co-infected with HBV and/or HCV will die more frequently than those mono-infected with HBV and/or HCV if they do not receive treatments for their disease.
Both studies come to the same conclusions: we need to increase primary prevention efforts to prevent co-infection with Viral Hepatitis (VH) from ever occurring, and we need to “thoughtfully revise access policies” (Breskin).
Isn’t that pleasant? “Thoughtfully revise” …why, if one listens closely enough, one might hear birds chirping and a babbling brook, so peaceful is this image.
Forgive my cynicism, but haven’t we really gotten beyond the point of politely asking for better access?
Since DAA drugs hit the market in 2013, marginalized populations have had to fight tooth and nail for better access to these drugs – it has taken dozens of lawsuits, both of the Class-Action and Civil varieties, to force state agencies and institutions to agree to open up access to these medications. States all around the U.S. have entered into settlements with Medicaid recipients and inmates; a handful of other states have chosen to fight litigation as high as they can, and virtually every ruling goes against them, forcing them to pony up the money to treat high-risk populations.
Perhaps these types of polite requests work in other, more civilized nations, where healthcare is considered a human right, rather than a cash cow to be milked dry. Here, in the U.S., however, it takes gumption and the willingness to fight. This has been true of HIV treatment; it is true of HCV treatment. And make no mistake: it will be a fight to gain open access to these medications.
In the meantime, until co-infected patients merit reliable access to HCV DAA drugs, they will continue to die faster than our mono-infected peers; they will continue to languish on wait lists, waiting for their livers to fail and suffer the extra-hepatic (non-liver-related) co-morbidities associated with untreated HCV. Maybe, if they ask politely, they will be given an extra comfy gurney upon which to do so.
- Breskin, A., Westreich, D., Hurt, C.B., Cole, S.R., Hudgens, M.G., Seaberg, E.C., Thio, C.L., Tien, P.C., & Adimora, A.A. (2019, January 07). The effects of hepatitis C treatment eligibility criteria on all-cause mortality among people with HIV. Clinical Infectious Diseases(ciz008). DOI: https://doi.org/10.1093/cid/ciz008
- Thornton, A.C., Jose, S., Bhagani, S., Chadwick, D., Dunn, D., Gilson, R., Main, J., Nelson, M., Rodger, A., Taylor, C., et al. (2017, November 28). Hepatitis B, hepatitis C, and mortality among HIV-positive individuals. AIDS 31(18), 2525-2532. DOI: https://dx.doi.org/10.1097%2FQAD.0000000000001646
Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.