Hepatitis Stakeholders Confront New Realities in March 2nd Forum

Canada's hepatitis community will meet in Victoria to discuss new guidelines for the management of hepatitis C and B recommended by liver specialists. Recent approval of costly but more effective new treatments, coupled with new US statistics showing viral hepatitis deaths surpassing those from HIV, assure that these guidelines will be of critical interest to a variety of stakeholders.  Major concerns include the criteria Pharmacare will use to determine the future eligibility for coverage.

This is a particularly critical time for BC's Ministry of Health and Pharmacare policy-makers responsible for addressing the province's HCV epidemic. As they lay out new treatment protocols, patient access criteria and Pharmacare coverage eligibility, policy-makers must somehow balance demands for fiscal responsibility with the efficient allocation of resources, long-term public health issues, and justice for individuals and their families. Unfortunately, as of today, though invited, no official from the Ministry of Health, nor from Pharmacare, has agreed to attend.  In lieu of his attendance, one Pharmacare official has consented to answer some written questions in advance.

Every year since 2007, more Americans have died from complications of chronic hepatitis C (HCV) than from HIV/AIDS, and those born 1945 through 1965  are most at risk (CDC, Feb. 20, 2012). There is no vaccine against HCV, and no 100% cure yet. The good news is that the rate of new HCV infection is decreasing steadily, and more effective new treatments for this 'silent killer' are becoming available.  In Canada, the picture is similar.  There are about 250,000 HCV+ Canadians, of which almost 55,000 live in BC. Sadly, Vancouver Island has one of the highest rates of infection in Canada (BCCDC, Aug. 18, 2010).

Many HCV+ people don't know they have it, as HCV commonly does its deadly damage to the liver and other organs 'silently' over 3 to 4 decades. Suddenly, a 60-year-old grandmother may discover she has advanced cirrhosis and won't survive without a liver transplant, or that she has liver cancer. The minor fatigue, rashes, stiffness, or digestive complaints she'd experience occasionally were all the warning she ever got that the transfusion or medical procedure she'd forgotten about, or that once-in-a-lifetime party that included IV drugs, or use of a cocaine straw, or that unsterile tattoo or piercing, had infected her with HCV back in her teens or twenties. Or maybe she was a nurse or dental assistant, always at extra risk of accidental needle-stick injury.

Fortunately for the spouses of HCV+ people, and contrary to other forms of hepatitis, HCV is only very rarely contracted during normal sexual activity.  HCV is spread only by direct blood to blood contact, such as when skin is penetrated by an object contaminated with another's blood.  Current BC guidelines require patients to provide
proof of considerable liver damage to get Pharmacare to cover HCV treatment. Some patients have even attempted to further damage their livers so as to qualify. However, current research shows that treatment is more likely to work the earlier it is provided, which would mean fewer lives and families devastated by disability, liver cancer, and transplant. Against this rapidly-shifting background, concerned voices with competing needs -- the medical profession, patients and caregivers, pharmaceutical companies, policy-makers who administer health insurance and disability benefits, and taxpayers --
are starting to be heard.

HepCBC, a charity run by and for people infected and affected by HCV, is offering a free, all-day, interactive public forum in Victoria (2101 Richmond Ave.) on Friday, March 2nd (9 to 4), where these various stakeholders can meet to hear and consider one another's perspectives. Five Canadian liver specialists will present new recommended guidelines for managing HCV. Each of their presentations will be followed by a public Q&A and comment period.  The public is invited, but as seating is limited, online pre-registration is required via www.hepcbc.ca .