Experts gathered at the 5th International Symposium on Hepatitis Care in Substance Users in Oslo, Norway, this week are discussing whether restrictions preventing substance users from accessing new hepatitis C drugs should continue. The experts believe that, as long as these restrictions exist, eliminating the disease will continue to be out of reach.
At the conference, researchers’ presentations will highlight the importance of treatment for substance users in reducing hepatitis C transmission, among other topics.
“The science is clear. We now need to focus on overcoming barriers to access, and harness latest research to implement programs that work,” Jason Grebely, associate professor at the Kirby Institute, University of New South Wales in Australia and president of the International Network of Hepatitis C in Substance Users (INHSU), said in a press release. “To delay further is unethical and undermines public health.”
“We strongly recommend that all restrictions on access to new hepatitis C treatments based on drug or alcohol use or opioid substitution treatment be removed. There is no good ethical or health-based evidence for such discriminations. Nor do the restrictions make clinical, public health or health economic sense,” said Prof. Olav Dalgard, chair of the INSHU 2016 Symposium.
It’s estimated that hepatitis C affects between 64 million and 103 million people worldwide. Innovative, highly effective curative treatments have sparked hope around the world, and disease elimination may be just around the corner if policies are adjusted.
The World Health Organization (WHO) has made a priority goal that by 2030, we see a reduction of 90 percent in hepatitis C diagnoses; reduction of 80 percent in people treated; and a 65 percent reduction in mortality caused by this life-threatening disease.
Substance use is among the main reasons people contract hepatitis C. In high-income countries, around 80 percent of new infections occur in people who use drugs. At the same time, this group has faced widespread exclusion from the healthcare system, particularly in accessing new therapies. Reasons for this phenomenon include elevated prices of new medications, fear of poor adherence, or concerns over effectiveness.
But now, global experience and international research are debunking these reasons.
Countries like Australia, France, and Iceland have already introduced hepatitis C elimination programs, offering unrestricted access. Australia is particularly on the spot, since more than 20,000 people (10 percent of the chronic hepatitis C population) have now begun treatment since subsidies have become available.
“Countries such as Australia and France have taken the lead in adopting evidence-based policies that will save lives. Now it’s time for other countries, including the U.S. and Norway, to follow their lead and allow all patients with chronic hepatitis C to be treated with the new drugs,” Dalgard said.
In addition, the globe’s largest clinical trial studying new hepatitis C therapies, the C-EDGE CO-STAR clinical trial (NCT02105688), has revealed that illegal drug use before and during hepatitis C therapy had no impact on its effectiveness and that reinfection rate was low, at only 4 percent. The trial results also demonstrated exceptional treatment adherence and cure rates that were comparable to results in hepatitis C populations that do not use drugs.
Another study, looking at Scotland, Australia and Canada, projected a three- to five-fold increase in treatment uptake among substance users in 15 years. In the U.K. and France, additional studies concluded that realistic treatment scale-up could achieve a reduction in chronic hepatitis C of between 15 and 50 percent in 10 years.
Experts also discussed the economic burden of treating substance users with moderate or mild hepatitis C with the new therapies. It is less expensive, in most cases, compared to delaying treatment until cirrhosis develops, they said.
Prof. Jeffrey Lazarus, of the Centre for Health and Infectious Disease Research, Rigshospitalet, University of Copenhagen in Denmark, is also presenting at the symposium.
“Providing treatment to people who inject drugs, integrated with harm reduction programs and linkage to care, is the key to hepatitis C program success,” Lazarus said. “And our experience in Copenhagen shows this can work. Such efforts need to be initiated and scaled up globally.”