HIV / AIDS Immunology Liver Disease Research

It’s ‘absolutely feasible’ to eliminate hepatitis C. Here’s how.

July 28 is World Hepatitis Day.

Hepatitis C testing has doubled in BC since 2011, yet there are still thousands of people in the province who have no idea they have the virus.

According to the BC Centre for Disease Control (BCCDC), nearly 270,000 British Columbians were tested for hepatitis C in 2018, up from approximately 132,000 in 2011. Still, an estimated 80,000 British Columbians are living with the virus and up to one-quarter of those are undiagnosed. About 2,500 new cases are identified in BC each year.

Hepatitis is an inflammation of the liver. In Canada, the most common types of viral hepatitis are A, B and C (learn about the difference). If left untreated, hep C can cause serious complications such as liver cancer, cirrhosis and even liver failure, which can be fatal.

Researchers at the BC Centre for Excellence in HIV/AIDS (BC-CfE) at St. Paul’s Hospital are monitoring and evaluating the hepatitis C epidemic in BC. With the awareness-raising World Hepatitis Day coming up on Sunday, July 28, BC-CfE research scientist Dr. Kate Salters shares the basics on hep C and explains what’s being done to eliminate the disease. Dr. Salters works with the BC-CfE’s Per-SVR study (PrEseRvation of Sustained Virologic Response – pronounced “persevere”) to monitor and evaluate the uptake of hepatitis C treatment throughout BC.

Dr. Kate Salters

Dr. Kate Salters

Who is most at risk of hep C in BC?

KS: Anyone is at risk of hep C in BC. The ways in which it can be transmitted are through blood-to-blood contact. This can include through medical procedures performed in unsanitary conditions and the sharing of needles or personal equipment like razors. In some cases, hep C transmission can occur through rougher sex. Baby boomers may have been exposed to hepatitis C during medical procedures when they were younger. It is important to ask a health care provider for a test.

Hep C is sometimes called a “silent killer” because many people don’t experience symptoms. How is this possible and how can people tell if they have the virus before it’s too late?

KS: It is estimated that one in five people living with hep C don’t know their status. Many people can live for up to 25 or even 30 years without having any signs or symptoms of the virus, but may still be able to pass it along. People who may be exposed to risk factors, particularly those in key groups such as injection drug users and men who have sex with men, should be tested. Individuals born between 1945 and 1965 are recommended to be tested for hep C in BC. BC-CfE research has found the prevalence in this generation could be linked to the increase in medical procedures and use of reusable syringes in boomers’ childhood years.

What is the treatment for hep C?

KS: New therapies for hep C are significantly different from the older interferon-based regimens. Now, an eight- to 12-week course of oral direct acting antivirals (DAAs) can cure hep C more than 95 per cent of the time. They are well tolerated and rarely cause side effects. The DAAs are also pan-genotypic, which means they work on a variety of types of hep C.

Can someone who has been cured get hep C again?

KS: Being cured of hep C does not mean you are immune to hep C going forward. This highlights the importance of harm reduction being provided alongside other supports and health services. Reducing the risk of hepatitis C can include supervised injection facilities and needle exchanges, as well as supporting access to health care. Reinfection can occur, but thankfully, therapies are still available in those cases.

What are researchers at the BC-CfE doing to address the hep C epidemic in BC?

KS: In BC, we have learned so much through our efforts to optimize the diagnosis and treatment of HIV through the successful, made-in-BC Treatment as Prevention® strategy for addressing the HIV epidemic. We have seen massive reductions in HIV incidence because we know how to better support expanded access to earlier testing and consistent treatment for people who are diagnosed. The BC Centre for Excellence in HIV/AIDS can take those valuable lessons and apply them to the hep C epidemic that is affecting 80,000 British Columbians through a Targeted Disease Elimination® strategy. Essential to an effective strategy is outreach that will help people “where they are” and will address social determinants of health, which can serve as barriers to health care. The more we are able encourage testing and linkage to appropriate care, the more likely we will be to start to control the hep C epidemic.

Per-SVR is an ongoing study of people who have been successfully treated for hep C. What do researchers hope to learn from this study?

KS: The BC-CfE is leading the Per-SVR study to evaluate the uptake of DAAs throughout the province. Particularly among marginalized groups, we want to learn about the health of people following completion of DAAs therapies and what types of tools, such as harm reduction, can be used to prevent reinfection of hep C. The information that will be provided through this research is critical to informing an effective strategy for addressing hep C.

Participants in the BC-CfE’s Per-SVR study have said that successfully completing treatment for hep C with DAAs was empowering, by lifting worries about the health of their liver.

Is it feasible to eliminate hep C in BC? What will it take to achieve this?

KS: It is absolutely feasible. We need to reduce barriers to testing, address the stigma facing people diagnosed with hep C, and make treatment more universally accessible. We still see significant barriers to DAAs for marginalized populations, particularly people who use drugs.

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