Hepatitis C

Hepatitis C

Stalking the hidden killer behind the opioid crisis.

Among the many trademarks that have been associated with Baby Boomers — tye-dyed t-shirts, changing the world and banning the bomb to name a few — a late-breaking one has a lot less count-culture appeal.  It’s an insidious, lurking viral infection known as Hepatitis C.  And it’s not just for boomers anymore.

It’s true that people born in the 40s through 60s account for about 75% of patients who are living with this chronic disease.  It’s a blood-borne infection, so many have assumed that it might be the intravenous drug abuse of that era that has revisited the now-aging boomers.  More likely, the infections were a result of inadequate blood protection protocols during medical procedures at the time.

But it is the abuse of drugs that has caused a resurgence of Hepatitis C infections among the young adults of today.  Charts have been tracking the diagnosis as it shadows the meteoric rise of opioid use for much more than a decade now.  The problem is everywhere including here in Kansas.

Hiding behind the headlines: A stealth killer.

Jennifer Sebes, APRN

“Opioid addiction is all over the news,” said Jennifer Sebes, APRN.  “You hear about drug overdoses all the time, and it’s having tragic consequences even in smaller towns in the midwest.  But people can overcome their addictions, and still carry with them the longer-term, life-threatening consequence of Hepatitis C.”

You can have the virus for years and not know it because it has no symptoms.  But it attacks the liver and over time, you could be looking at either a liver transplant or death.  For many years, the treatment for Hepatitis C was, true to cliche, worse than the disease.

“You would go from feeling symptomless and fine to feeling like you had the worse case of flu in your life for an entire year,” as Jennifer described it. “Treatment was with a couple of drugs that stimulated the immune system to fight the disease and were not as effective as we would have liked.  It was the best care we could offer at the time, but only about 25 to 50 percent of patients had a positive outcome.”

The treatments were incredibly expensive, and the side effects were so terrible that it was hard to sustain the patients’ compliance with the therapy for the year-long regimen.

Then there was the issue of access to care.  For patients who didn’t have insurance, it was a sort of “Catch 22” dilemma.  Treatment required referral to a specialist, but specialists would not accept patients without insurance.  In Wichita, at the time, there were very few options for the uninsured to get treatment.  It wasn’t long before the clinic where Jennifer was seeing patients had to discontinue their Hepatitis C program because of the side effects of the drug were too difficult to manage.

Defusing the threat with smarter, safer drugs.

Then, in the fall of 2014, Hepatitis C treatment options were suddenly transformed.  Drugs that attacked the virus directly, dubbed direct-acting antivirals, were developed that doubled the cure rate and required only 12 weeks of treatment with a much more patient-friendly profile of side effects.

The cost of the medication was still stunningly expensive. But because it could be taken by itself and not in combination with other drugs, the overall cost was reduced.  Jennifer was able to work through GraceMed’s Prescription Assistance program to get free medications for qualifying patients.  Working out of our Good Samaritan Clinic in Wichita, she restarted the Hepatitis C treatment program she had once abandoned.  Along the way, she picked up a new recruit in the person of Angela Kocher, APRN who sees patients at our Downing Clinic.
Angela Kocher, APRN, FNP-C

“As far as a cure for Hepatitis C is concerned, we’ve really moved from hit-and-miss at best to better than 90% cure rate within just several weeks of treatment,” Angela said.  “For the patient populations that GraceMed sees, it’s still a challenge to cover the cost, but between Medicaid coverage and discounts offered by the drug companies, we are able to get our patients the care they need.”

What making a difference looks like.

Jennifer is enthusiastic about the impact she has seen in her patients’ lives. “It’s amazing enough that we can free them from a death sentence.  But for some, it’s like a weight has been lifted from their lives, and they start to believe that anything is possible now.  It’s just exciting to be able to make such a huge difference when just a handful of years ago, we were unable to offer much hope.”

Ultimately, the story of the war against Hepatitis C highlights the mixed blessing that advances in drug therapies can be.  The nation is still groaning under the weight of raging opioid addition. It’s a legacy of tragic loss created by the abuse of medications that were meant to treat pain, not cause it.  The introduction of a new generation to drug abuse has contributed to the dramatic rise of Hepatitis C to become the number one cause of death among infectious diseases.  But on the back end of the story, another new drug therapy has emerged, transforming a virtually hopeless condition with the promise of a real cure.