Tag Archives: Baby Boomers

Generational Stigmata and HCV

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

When it comes to Hepatitis C (HCV), people in America have long assumed that it was (and is) a Baby Boomer problem. Recent statistics, however, indicate that a rapidly increasing number of new HCV diagnoses are linked to Injection Drug Use (IDU), and that IDUs will likely lead to an exponential explosion of new infections compared to previous years. With that reporting, however, a stigma has arisen amongst the Baby Boomer population (the Birth Cohort), leading some in the cohort to avoid screening for the disease. Research published in March 2016 (Joy, 2016), however, indicates that HCV infections within the Birth Cohort is much more likely to have arisen from unsafe medical practices on behalf of doctors and hospitals, rather than any lifestyle choices made on the part of patients.

The research, published in The Lancet Infectious Diseases journal, was conducted by scouring over 45,000 documents and records, examining 45,316 sequences of HCV Genotype 1a – the most common strain – and then used a technique called “phylogentic analysis” to focus on five HCV genes and trace the dynamics of the HCV epidemic. The results suggest that the initial peak of the HCV epidemic – the time when initial infection and introduction of the disease in the Birth Cohort – occurred between 1948 and 1963, far earlier than many had suggested.

These infections are most likely related to the techniques and equipment that medical professionals used in the post-World War II (WWII) era, prior to the establishment of safer technologies, equipment, blood screening, and techniques that came about in the wake of the initial HIV crisis of the 1980s and 1990s. Strict blood screening techniques were not, in fact, common place until the U.S. government mandated the practice in 1992. As such, anyone who received a blood transfusion or underwent invasive medical procedures prior to that year may have been exposed to HCV, and should be screened for the virus.

Stigmata are nothing new, however, for the Birth Cohort. This is a group who helped to push the sexual revolution and drug use of the 1960s and 70s, and began having children in the 1980s. During this time, reports of sexually transmitted diseases and viruses, as well as transmission via IDU, began gaining more media exposure, both of which gained a level of ignominy in the 1980s in relation to HIV. We must remember that many media reports indicated that HIV only impacted those in the “4 ‘H’ Club” – Heroin users, Hookers, Haitians, and Homosexuals. When this type of branding in the media and in government conversations occurs, stigmata arise that leads to people avoiding testing and treatment.

Since that time, however, infectious diseases have undergone something of facelift, with multi-million-dollar ad campaigns and outreach programs on the part of pharmaceutical companies and governments trying to spread the word about getting tested. These efforts are part of a concerted effort to reduce the stigma associated with chronic illnesses and infectious diseases that are both costly to treat and incredibly harmful to those living with them if they go untreated.

For the Birth Cohort, however, to feel as if they should be lumped in with what many view as an unsavory crowd simply goes counter to the reality of the epidemic. Screening for HCV isn’t just something that applies to those who practice risky behavioral patterns; rather, it should be something that is routine within the Birth Cohort, so that they can cure HCV and live their waning years without the concern of HCV-related illnesses and co-morbidities.

References:

  • Joy, J., McCloskey, R., Nguyen, T., Liang, R., Khudyakov, Y., & Olmstead, A., et al. (2016, March 30). The spread of hepatitis C virus genotype 1a in North America: a retrospective phylogenetic study. The Lancet Infectious Diseases16(6), 698-702. doi:10.1016/s1473-3099(16)00124-9. Retrieved from: http://dx.doi.org/10.1016/S1473-3099(16)00124-9

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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.

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Lessons Learned About HCV and Aging

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

On Thursday, December 8th, the Community Access National Network (CANN) hosted a community roundtable on Hepatitis C (HCV) and Aging at the Pharmaceutical Research and Manufacturers of America® (PhRMA) headquarters in Washington, D.C. The event featured four presenters – Ambrose Delpino (PharmD, practicing HIV pharmacist [AAHIVP], Senior Manager, Virology, Walgreens), Fabian Ancar (a patient who successfully achieved a Sustained Virologic Response [SVR] while co-infected with HIV and HCV), Marissa Tonelli (Senior Manager of Capacity Building, HealthHIV, and Senior Manager of HealthHCV), and Chris Taylor (Senior Director, Hepatitis, National Alliance of State and Territorial AIDS Directors).

Of the four presenters, Dr. Delpino presented the most statistically pertinent presentation (as the others spoke primarily about their experiences, research, and how their organizations engage in advocacy on the local, state, and Federal levels), and the statistics that we’ll be reporting, here, are from his slides. Some of the issues raised during this panel will be further explored in further posts, so this entry will serve as a summation of his main points.

On the basics of infection, Dr. Delpino’s presentation reported that 2.7–3.9 million Americans are estimated to be infected with HCV, with an estimated 17,000 new infections annually. Both he and HEAL Blog note that this estimation is likely very low, as HCV screening, disease monitoring, tracking, and reporting are notoriously problematic, as capturing certain populations (e.g. – Rural, People Who Inject Drugs (PWIDs), et cetera) is difficult at best. It is also estimated that one in thirty Baby Boomers (people born between 1945-1965) are infected with HCV – five times greater incidence than other adults. The estimated cost to the healthcare system, including HCV-symptom-related hospitalizations and treatments is estimated to be over $80 billion over the next ten years.

The primary reason why Baby Boomers (the “birth cohort”) are so much more likely to be infected is related to the facts that HCV is a relatively new discovery in terms of diseases, blood supplies were not adequately screened for HCV prior to 1992, and universal precautions related to sanitation were not, prior to the discovery of HIV, necessarily the standard of care (SOC). This means that anyone who received a blood transfusion or any other blood product prior to 1992 is at risk of having contracted HCV; this also means that anyone who received transplanted organs or had improperly sterilized equipment used on them prior to universal precautions being in place is also at risk.

Outside of the birth cohort, it is estimated that 60% of all HCV infections are believed to be related to injection drug use (IDU). For every 100 people infected with HCV, 75-85% will develop a chronic infection, 60-70% will develop liver disease, 5-20% will develop liver cirrhosis, and 1-5% will die as a result of their infection. What makes this frustrating for HCV advocates is that the cost per SVR in a single 12-week round of the most popular treatment (Harvoni – $94,500) is far less expensive in the short term than the long-term costs associated with chronic HCV infection.

In future posts, we will be examining the pipeline process that it often takes for patients infected with HCV to receive medications to treat their disease, one of the most compelling slides in Dr. Delpino’s presentation. We will also be sharing some of the personal testimony of the patient, Fabian Ancar, whose story was presented at the panel.

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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.

 

 

 

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Hepatitis C and Aging

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award

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.

BORN 1945-1965? CDC recommends you get a blood test for Hepatitis C

Photo Source: Examiner

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.

 

References:

  • 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

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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.

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