World Hepatitis Day 2017 - Eliminate Hepatitis

World Hepatitis Day 2017 - Eliminate Hepatitis

‘World Hepatitis Day is one of just four disease-specific global awareness days officially recognised by the World Health Organization (WHO).’ WHD is the day when the world joins together to drive action, to transform the lives of 325 million people living with the disease and to play a part in the fight to eliminate viral hepatitis by 2030. Viral hepatitis is one of the leading causes of death globally, accounting for 1.34 million deaths per year – that’s as many as HIV/AIDS, tuberculosis or malaria. Together, Hepatitis B and Hepatitis C cause 80% of liver cancer cases in the world.

Viral hepatitis is not found in one location nor amongst one set of people; it is a truly global epidemic that can affect millions of people without them even being aware. Currently, 90% of people living with Hepatitis B and 80% living with Hepatitis C are not aware of their status. This can result in the real possibility of developing fatal liver disease at some point in their lives and in some cases, unknowingly transmitting the infection to others.’i

New Zealand’s Hepatitis B vaccination programme commencing in the 1980’s has resulted in new childhood infections being largely eradicated and overall greatly reducing the number of people in New Zealand with this disease. However Hepatitis C was never made notifiable so exact numbers are unknown.

Hepatitis C is spread through blood to blood but it’s not until Hepatitis C is perceived as a virus needing treatment rather than ‘how did you get it’ will the elimination of Hepatitis C be achieved as many people still feel stigmatised and discriminated by the virus.

In the last 18 months there have been a major breakthroughs in the treatment and the accessing of treatment for Hepatitis C. Direct acting antivirals, funded by Pharmac are replacing interferon-based treatment for Hepatitis C genotype 1. These are simple medication regimes of a few tablets per day and GP’s are now able to treat making it no longer necessary for the majority of people to attend hospitals. No longer is a liver biopsy mandatory for the assessment; it has been replaced with a Fibroscan®. A simple, painless non-invasive test taking 5 – 10 minutes to complete and performed through the Gastroenterology Departments in New Zealand.

Pharmac needs congratulating on funding ‘Viekira’ for all people with Hepatitis C genotype 1 regardless of their stage of liver disease unlike in the UK where liver fibrosis is a pre-requisite for funded treatment. Since July 2016 when this medication became funded in NZ, over 2000 people are now cured. For patients of all genotypes with advanced liver disease Viekira treatment is contraindicated. For these patients Pharmac has funded Harvoni treatment. As from the 1 July 2017 the criteria were lessened to allow more people to access this treatment.

However we still have a way to go as all other genotypes have no acceptable Pharmac-funded treatment options despite those being on the market. Medsafe has given approval for the importation of generic medications costing approximately $2000 to be purchased through the FixHepC Tasmanian Buyers Club. These medications have good efficacy and this initiative is endorsed by the New Zealand Society of Gastroenterology and the Hepatitis Foundation. It is not equitable nor is it fair as the majority of the people affected are unable to afford these medications and some DHB’s refuse to treat and or monitor patients on these medications.

On clearing the virus – cured - which in medical terms is a sustained virological response (SVR) most people’s livers recover and providing they had not developed liver cirrhosis pre-treatment their all cause morbidity and mortality returns to normal. People with cirrhosis also have improvement in their liver function and quality of life. Untreated Hepatitis C impacts on people’s quality of life resulting in a huge economic burden to New Zealand both in sickness and inability to work due to profound lethargy the most common symptom of hepatitis C. The message is to get tested and get treated now.

ENDS