Know HCV Status to Take Effective New Medicines
There are obstacles, but a cure is at hand
September 1, 2023
Healthcare workers could access effective medications with few side effects by testing for hepatitis C virus (HCV) and pursuing treatment.
The prevalence of HCV in U.S. healthcare workers is unknown, but a systematic review and meta-analysis study by German researchers “indicates that the prevalence of infection is significantly higher in healthcare workers than in the general population. The highest prevalence was observed among medical and laboratory staff.”1
Moreover, the same research group noted in a different paper the sooner treatment begins the better, as two-thirds of medical workers recovered, but “liver cirrhosis proved to be a predictor of a statistically significant reduction in success rates.”2
The CDC estimates 2 million Americans are infected with HCV, but about 40% are unaware. A combination of factors, including expensive treatment and bureaucratic obstacles with insurance and referral policies, translate to nearly 15,000 HCV deaths annually in the United States.3 Needle-sharing during the opioid epidemic has driven rates of HCV higher, and into a younger population. HCV can be transmitted by blood exposures, and less often by sexual activity. HCV in healthcare workers often is a result of needlesticks, blood splashes to mucous membranes, and drug diversion.
“It’s known as the silent killer because initial infection usually has few to no symptoms,” Jonathan Mermin, MD, MPH, director of the CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention, said at a recent press conference. “But over time, the virus can slowly cause damage to the liver. It can cause liver cancer, liver failure, and death.”
Point-of-Care Test Needed
Francis Collins, MD, PhD, a former director of the National Institutes of Health, said the current HCV testing protocol is too cumbersome. The FDA has been asked to approve a point-of-care rapid test available in Europe and Australia.
“You need first an antibody test, and then an RNA test, and those have to be sent away to central laboratories,” Collins explained. “There can be a long delay, and we lose a lot of people along the way. The point-of-care test gives a result in an hour or less. The goal being then to get testing and treatment [started] in a single visit.”
Generally, the treatment is one pill a day for eight to 12 weeks. “A lot of people remember the bad old days when the treatment for hepatitis C was very toxic — involving interferon — and didn’t always work,” Collins recalled. “That is not the case now. The available cure is safe, highly effective, and very well tolerated.”
Collins is involved in a negotiation with drug manufacturers to lower costs and expand treatment access to impoverished people. Most of the cost should be covered for healthcare workers with good insurance, but the expense of the medications has led to insurance obstacles. “The cost of the therapy has been a real barrier to many programs,” Collins said.
“Health coverage policies often make it difficult for people with hepatitis C to access treatment,” said Carolyn Wester, MD, director of the CDC Division of Viral Hepatitis. “Due to the high cost of treatment, some payers limit which patients are eligible for treatment, or require burdensome preauthorization before treatment can begin, or even limit the types of providers who can prescribe treatment. All of these restrictions can delay or even prohibit access to these lifesaving medications.”
Wester and CDC colleagues found “jarringly low cure levels across the board for people diagnosed with hepatitis C” in a recent study. They studied commercial laboratory data from more than 1 million people nationwide who were diagnosed with HCV between 2013 and 2022 — a period during which treatment was available. They found only one-third of people with diagnosed HCV cleared the virus and were cured.4
“Only one in six adults under the age of 40, without health coverage, were cured,” Wester said. “The highest cure rates were among adults 60 years and older who had Medicare or commercial insurance, yet less than half of these folks were cured. This is mostly because insurers have placed obstacles in the way of people and their doctors, preventing patients from accessing treatment.”
These barriers include requiring consultation with a specialist, sobriety, and evidence of liver disease to obtain treatment, Collins said. To that last one, he added, “Does that make sense? We’re trying to prevent liver disease.”
REFERENCES
1. Westermann C, Peters C, Lisiak B, et al. The prevalence of hepatitis C among healthcare workers: A systematic review and meta-analysis. Occup Environ Med 2015;72:880-888.
2. Westermann C, Wendeler D, Nienhaus A. Hepatitis C in healthcare personnel: Follow-up analysis of treatments with direct-acting antiviral agents. J Occup Med Toxicol 2021;16:34.
3. Centers for Disease Control and Prevention. Breakthrough cures for hepatitis C still fail to reach the vast majority of Americans who need them. June 29, 2023.
4. Wester C, Osinubi A, Kaufman HW, et al. Hepatitis C virus clearance cascade — United States, 2013-2022. MMWR Morb Mortal Wkly Rep 2023;72:716-720.
The prevalence of hepatitis C virus infection is significantly higher in healthcare workers than in the general population. Healthcare workers could access effective medications with few side effects by testing for the virus and pursuing treatment. However, high costs and insurance barriers hinder these efforts.
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