Risk factors for having a hepatitis C infection include: injection drug use now or in the past; blood transfusion prior to 1992; being on long-term hemodialysis; incarceration; using intranasal drugs; having an unregulated tattoo; and exposure to blood as a health worker (for example, from a needle stick).
Approximately 2.7 million Americans have a chronic hepatitis C infection. Between 1 and 5 percent of these people will die from cirrhosis or liver cancer. A resurgence of injection narcotic use has also led to infections in young adults under the age of 30 in the U.S.
Though the virus wasn’t discovered until 1989, public health data suggest it was being transmitted decades prior to that time. People born from 1945 to 1965 or baby boomers are five times more likely to have hepatitis C. Unfortunately, African Americans born during these years have twice the rates as other baby boomers. While African Americans represent only 12 percent of the U.S. population, they make up roughly 22 percent of the estimated 3.2 million persons with chronic HCV infection. Moreover, chronic liver disease, often hepatitis C-related, is a leading cause of death among African Americans ages 45-64.
Hepatitis C is more prevalent among African Americans than among persons of any other racial group in the United States.
Strategies to improve outcomes in African Americans include higher doses of current medications, medications with fewer adverse events and new experimental molecular therapies. African Americans are usually underrepresented in clinical trials of treatment for acute and chronic HCV infection, even though their prevalence of chronic HCV infection is higher than among whites. African-American subjects currently represent only 5 to 10 percent of participants in clinical trials involving HCV infection.
Traditionally, some people may be reluctant to be tested or seek treatment because of serious and often debilitating side effects associated with the previous standard of care for treating HCV, which included injections of interferon-alfa. Furthermore, interferon-based treatment resulted in cure rates among African Americans that were significantly lower than among whites, highlighting the need for new treatment options to increase the possibility of cure for all patients.
For years, it was unclear why African Americans did not respond well to interferon. Finally, in 2009, it was discovered that African Americans are much less likely to inherit genes that allow interferon-based treatment to work by helping liver cells eliminate the HCV. It was clear that in order to improve HCV cure rates for African Americans, alternative treatments would be needed.
Recent advancements in the fight against hepatitis C have transformed the disease from one that can, at best, be controlled to one that can be cured for a majority of people who have it. The past four years have seen significant advances in HCV treatment, with several new drugs coming to market that can now cure HCV in a shorter period of time and with fewer side effects.
A downside to the massive drug development efforts that proved so successful is the hefty cost of treatment. What’s hefty? Try $1,000 per pill, taken once per day, for 12 to 24 weeks. A three-month course of Hepatitis C treatment typically runs between $80,000 and $120,000.
About 1 million Americans with HCV are thought to be covered by Medicaid, a joint state-federal program for the poor. By law, Medicaid and Medicare are required to cover medically necessary treatments; they can’t exclude an entire class of medications that are proven effective for cost considerations alone. Last year, the Centers for Medicare & Medicaid Services said a drug for a specific disease may be denied only if “the excluded drug does not have a significant, clinically meaningful therapeutic advantage in terms of safety, effectiveness or clinical outcomes.”
After legal battles and lobbying efforts, thousands of people with hepatitis C are gaining earlier access to expensive drugs that can cure this condition. States that limited access to the medications out of concern over sky-high prices have begun to lift those restrictions — many, under the threat of legal action.
The drugs in question — Sovaldi and Harvoni from Gilead Sciences, Viekira Pak from AbbVie Inc., and Zepatier from Merck & Co., among others — eliminate the hepatitis C virus over 90 percent of the time, a cure rate almost double that of earlier therapies. The latest HCV drug to enter the market, Gilead Sciences’ Epclusa, received approval from the Food and Drug Administration last week.
By raising greater awareness in African-American communities and making best use of these new curative treatments we can decrease or eliminate the health disparities faced by African Americans living with HCV.
July 25 is the 4th Annual National African American Hepatitis C Action Day. Spread the information, and save lives.