Hepatitis C killing thousands despite treatment advances

Structure of Hepatitis C Virus.

Hepatitis C Virus (HCV) remains responsible for the deaths of 290, 000 people every year despite major advances in treatment.

This is according to a July 27, 2021 press statement by Unitaid on the global status of efforts to eliminate the viral disease by 2030.

HCV is a blood-borne virus that can lead to serious liver damage, including cancer, when left untreated. It is the number one cause of liver cancer and transplants, and is mainly detected in cases when medical tests show liver damage.

At an early stage, HCV may cause lack of appetite, muscle and joint pain, fever, jaundice, which is a yellowish tone on the skin and eyes, stomach pain, fatigue, nausea, and dark urine.

On the other hand, advanced HCV infection may consist of itchiness, bleeding or bruising easily, confusion, fluid accumulation in the abdomen, weight loss, swelling in the arms and legs, slurred speech and blood vessels taking on a spider-like appearance.

According to a report by Dr Janet van Vlymen and colleagues, Hepatitis C virus can be transferred into commonly used medications when using sterile single-use needles and syringes where it remains viable for several days.

To prevent HCV infection, do not share needles or razor blades. Avoid getting new piercings or tattoos from artistes who do not operate in a sterile, hygienic environment. 

Always practice safe sex. Use a condom or abstain from intercourse in cases of uncertainty.

Many patients, unfortunately, fail to access timely and effective treatment for lack of awareness and inadequate access to diagnostic tools.

Kenya is rated as having a moderate to high prevalence rate of 5-7 percent on the Centre for Disease Control (CDC)’s list of travel-related infectious diseases.   

Bangladesh, China, Georgia, Haiti, India, Kenya, Mauritania, Mongolia, Namibia, Pakistan, Peru, Uganda, Ukraine, United Republic of Tanzania, Uzbekistan, Vietnam, and Zambia are among the countries that the CDC has worked with in the improvement of viral hepatitis prevention and control efforts.

About 58 million people are estimated to be infected with hepatitis C around the world. Only one or five or 21 percent of these receive a diagnosis of their condition.

World Hepatitis C Day is marked on July 28 every year to take stock of efforts to prevent, control and ultimately eliminate the disease by 2030. 

Unitaid is a global health agency that seeks innovative, cheap and effective solutions to prevent, diagnose and treat diseases in low- and middle-income countries.

Its efforts include funding initiatives to address major diseases such as HIV/AIDS, malaria, and tuberculosis, as well as HIV co-infections or co-morbidities such as cervical cancer and hepatitis C, and related issues like fever management.

According to Unitaid that is hosted by the World Health Organization (WHO) poor, displaced and marginalized, displaced populations are disproportionately affected by the Hepatitis C disease burden.

Particularly at risk are people who inject drugs and those living with HIV.

In 2016, the World Health Organization (WHO) set a target for the elimination of hepatitis as a global health threat by 2030. Efforts to reach this target so far remain encouraging, the UN body says.

The milestones reached include the reduction of active cases by 13 million in the last 6 years.

“We are already seeing encouraging progress that shows us that meeting WHO targets is possible. Since 2015, hepatitis C-related deaths have decreased by more than 25 percent, and the total number of people infected has fallen from 71 million to 58 million today. Thanks to the work of Unitaid and our partners, we now have the tools we need to fight hepatitis C and achieve these goals – but there is no time to waste,” said, said Janet Ginnard, Director of Strategy at Unitaid.

She praised the bold initiative undertaken by Egypt and Rwanda in scaling up treatment and diagnosis for patients, urging other nations to do the same.

“Certain pioneering countries, such as Egypt and Rwanda, are already making this happen. They are proving that we can reach people infected with hepatitis C, connect them to services, save lives and drive down the disease burden. We now need other countries to follow suit,” .

Unitaid says effective treatment of the viral disease is only possible with timely and accurate diagnosis.

“But treatments have little effect if people do not know they are infected. Diagnosing hepatitis C previously required complex labs and specialist technicians, making testing expensive and inaccessible,” reads the statement.

As part of efforts to address this challenge, Unitaid has supported the development and scale up of simple diagnostic tools as well as showing how they can be used to improve access by vulnerable people and through local health facilities.

“Unitaid has proven that simplified testing and treatment for hepatitis C at local healthcare centres is not only feasible – including in resource-limited settings – but highly effective. With more than Sh 4.9 billion or USD 45 million invested since 2015, we brought down prices for medicines, simplified testing and raised awareness of these innovations,” said Ms Ginnard.

The Unitaid strategy boss says the new approaches could play a significant role in saving lives.

“These methods, if implemented wide scale, hold the key to averting thousands of needless hepatitis-related deaths each year,” Ms Ginnard said.

Medical advances in the recent past have shortened the treatment time to just three months for nine out of ten or more than 90 percent of people treated.

Previously, treatment that consisted of interferon injections and ribavirin pills would last up to a year, and had a cure rate of 50 percent with serious side effects.

The old therapy did not attack the virus but amplified the body’s immune response to fight off the infection.

New therapies that directly target the virus and can clear it within 8 to 12 weeks include daclatasvir, elbasvir and grazoprevir, ledipasvir, gecaprevir, simeprevir and sofosbuvir.

Unitaid and its development partners have worked to make the medicines cheaper for cash strapped patients. As a result, a full course of treatment is now available for Sh 32,550 or USD 300 or less in most low- and middle-income countries, compared to several thousands of dollars in high-income countries.

Unitaid is now funding research into the development of a single-injection cure for hepatitis C.

“As the COVID-19 pandemic continues to strain health systems in resource-limited settings, it is more essential than ever that we bolster our progress against hepatitis C and avert preventable disease”, said Ms Ginnard.

Unitaid’s work has made cheaper medical care possible for hepatitis C patients in countries including Cambodia, Georgia, India, Malaysia, Morocco, Myanmar, and Thailand. This includes getting price cuts for vital drugs such as daclatasvir and sofosbuvir.

This was done through price reduction agreements and voluntary licensing arrangements in more than 100 low- and middle-income countries. Using this experience and knowledge, Unitaid has developed applicable solutions to expand its global hepatitis C treatment program.

Unitaid serves as key member of the Access to COVID-19 Tools (ACT) Accelerator. Here, its expertise is a vital pillar in addressing challenges posed by the development of new therapies and diagnostics for the COVID-19 pandemic.

Partners involved in the 2030 HCV elimination drive include Médecins Sans Frontières (MSF), Foundation for Innovative New Diagnostics (FIND) Coalition PLUS, Medicines Patent Pool (MPP) and the World Health Organization (WHO).

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