By: Marcus J. Hopkins, Blogger
While we, here at HEAL Blog, have spent much of the year focusing on the vast increase in new Hepatitis C (HCV) infections amongst the Injection Drug User (IDU) population, what often gets left out of that picture is the effect that Chronic HCV has upon the aging Baby Boomer population. According to the U.S. Centers for Disease Control and Prevention (CDC), of the estimated 3.2 million people chronically infected with HCV in the U.S., approximately 75% were born between 1945–1965 – Baby Boomers (CDC, 2015). As such, the Community Access National Network (CANN) will be hosting a panel on HCV and Aging this December 08, 2016, in Washington, D.C.
Baby Boomers have faced significant risks that make them more likely to have been infected with HCV, not the least of which includes blood transfusions received prior to 1990, when routine screening for HCV became the norm. Additionally, because HCV may take many years to manifest, many people are unaware that they are infected, with estimates ranging from 45% – 85% (CDC, 2015). Additionally, recent CDC reports indicate that HCV kills more Americans than any other infectious disease (CDC, 2016), despite being a curable condition. Roughly half HCV-infected patients often fail to receive appropriate treatment, because they are unaware that they are infected.
For those patients who are aware of their condition, there is often fear associated with HCV treatments. HCV treatment has long been considered one of the least tolerated therapies in medicine, with older Pegylated interferon-based treatments requiring long regimens that left patients sick and unable to function. With the introduction of the Direct Acting Agents (DAAs), Sovaldi (Gilead) and Olysio (Janssen), in 2013, these concerns related to the tolerability of drugs were largely mitigated. In 2013, there were two DAAs specifically aimed at treating HCV; in November 2016, there are now nine different drugs on the market to treat various genotypes of HCV – Sovaldi, Olysio, Harvoni (Gilead), Viekira Pak (AbbVie), Daklinza (Bristol-Myers Squibb), Technivie (AbbVie), Zepatier (Merck), Epclusa (Gilead), and Viekira XR (AbbVie). Epclusa, released in July 2016, is also the first pan-genotypic DAA that can treat HCV across all genotypes. These HCV DAAs are not only more easily tolerated, but also have shorter treatment times (between 12-24 weeks, with current testing for 8-week courses).
Though the tolerability of HCV treatments has been largely addressed with these newer DAAs, new concerns have risen regard the cost of the regimens, ranging from $54,000 – $94,500 for twelve weeks of treatment (Zepatier and Harvoni, respectively). In addition, Medicaid, Medicare, Ryan White, and private insurers alike have imposed strict Prior Authorization pre-requisites for approving these treatments, many of which include waiting until liver fibrosis scores (scarring levels) have reached a certain severity before they will approve a patient for these regimens. These pre-requisites often include a daunting amount of paperwork that must be filed, several denials, and abstinence from various activities for extended periods before considerations will even begin to be made. These barriers prevent many Baby Boomers from receiving life-saving treatments that should be routine, but because of cost-related issues are often not.
Despite these concerns, testing for HCV is still not a requirement in emergent care situations, regardless of recommendations by the CDC. With HCV being the leading cause of infectious disease-related deaths, it is imperative that we, as a nation, take better care of our seniors, and all become more aware of the risks posed by Chronic HCV.
- Centers for Disease Control and Prevention. (2015, May 31). Viral Hepatitis – CDC Recommendations for Specific Populations and Settings. Atlanta, GA: Centers for Disease Control and Prevention: National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention: Division of Viral Hepatitis. Retrieved from: http://www.cdc.gov/hepatitis/populations/1945-1965.htm
- Centers for Disease Control and Prevention. (2016, May 04). Hepatitis C Kills More Americans than Any Other Infectious Disease. Atlanta, GA: Centers for Disease Control and Prevention: Newsroom. Retrieved from: http://www.cdc.gov/media/releases/2016/p0504-hepc-mortality.html
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.