Hepatitis C kills more in US than HIV

Studies show that deaths from hepatitis C (HCV) infection among US adults  outnumber AIDS fatalities. And while greedy pharmaceutical giants advertise new  drugs that cost a fortune, Oxford dons claim success in developing anti-HCV  vaccine.

­Hepatitis C virus, or HCV, causes serious liver infection which can  eventually lead to fatal liver scarring (cirrhosis) and liver  cancer. It usually passes with infected  blood, and therefore, most people contract the disease in medical facilities  through improperly sterilized medical instruments or while injecting drugs with  shared needles.

Up to 80 per cent of all cases end with chronic infection, when the virus  persists for many years, quietly damaging the liver and rarely causing any  noticeable symptoms.

However, hepatitis C can turn  deadly very quickly, especially when alcohol is involved on a regular basis.  Another piece of bad news is that HCV is extremely difficult to get rid of, as  well as it is the only type of hepatitis infection which cannot be prevented by  vaccination.

­Alarming trend

­Up to 170 million people are estimated to be infected with HCV  worldwide, says the World Health Organization. However, the fact that the virus  lacks visible symptoms could mean that the real figure is much higher. In Egypt  alone, staggering 22 per cent of the population is HCV-positive, making it the  world’s worst-affected country.

In the United States, HCV appears to be killing more people than HIV – the  virus that causes AIDS. The shocking results were published on February 21 in  Annals of Internal Medicine by the team led by Dr. John Ward of the US-based  Centers for Disease Control and Prevention (CDC). Their data show that in 2007,  hepatitis C killed 15,100 Americans, whereas about 12,700 deaths were registered  as HIV-related.

Another alarming conclusion is the trend. While HIV-related deaths have  declined between 1999 and 2007, the recorded data for hepatitis C has shown a  significant increase. Moreover, because these figures are based on death  certificates, they almost certainly underestimate the real scope.

“The big issue is that most people with chronic infection are still not  identified,” Dr. Harvey Alter, a researcher with the National Institutes of  Health told Reuters.

Hepatitis C prevalence, data by the WHO (World Health Organization), 1999Hepatitis  C prevalence, data by the WHO (World Health Organization), 1999

­Why ‘baby boomers’

­Approximately two thirds of all chronic HCV infections in the US are  found in people born between 1945 and 1964, so-called “baby boomers”. Such  predominance can be explained by the widespread injection-drug use between 1960s  and 1980s, and a common practice to share needles.

Other routes for the infection included blood transfusion and organ  transplantation, before the universal screening was introduced in the United  States in 1992. It is worth mentioning that many countries still do not screen  blood donations for hepatitis C due to the cost.

On the bright side, screening programs among risk groups, such as baby  boomers in the US and Europe, could make big difference in fighting this  disease, provided recent advances in treatment. CDC estimated that screening  baby boomers would uncover extra 808,580 cases of hepatitis C in the US  alone.

­Treatment: Pay or die

­Helpless before the virus as recently as 20 years ago, medicine  announced tactical victory when a combination of two medications – interferon  and ribavirin – was found to cure between 45 and 80 per cent of patients,  depending on the viral genotype (with genotype 1 – the most common in Americas  and Europe – being the most difficult to treat).

In spring 2011, the US health authority, FDA, approved two new oral drugs  that could send the cure rate in hard-to-treat genotype 1 patients from 45 to  impressive 70 per cent, if combined with interferon and ribavirin. The  life-saving medications are boceprevir (trade name Victrelis), developed by a  pharmaceutical giant Schering-Plough, and telaprevir (Incivek) by Vertex and  Johnson Johnson.

“Great!” you may think, “Then what are they waiting for?”Apart from their own citizens, the human-rights-concerned United States could  now help the people of Egypt, to begin with, provided that health is one of  those fundamental human rights democratic societies stand for. But in the real  world, exporting NGOs to back anti-government protests, as well as tear  gas canisters to suppress those protests, may prove to be easier than  convincing pharmaceutical giants to sacrifice a small share of their colossal  profits and make the price of life-saving drugs somewhat tolerable.

With Incivek costing nearly US $50,000 for the course and Victrelis ranging  between US $26,000 to US $48,000, depending on the duration of treatment, the  future without hepatitis C may prove to be a more distant perspective – especially for those without access to first-class medical  insurance.

­Vaccine: all eyes on Oxford

­Still, every cloud is supposed to have a silver lining, and every  infection is better to prevent than to treat. Despite the fact that anti-HCV  vaccine has not yet been developed, early clinical trials have yielded promising  results, according to a team of Oxford University researchers.

Forty-one uninfected patients were given the vaccine, which the scientists  said created a strong immune response for a year or more without any significant  side effects. In their recent publication in Science Translational Medicine,  researchers say the next step will be to give at-risk members of the population  the vaccine to see if it can prevent them from being infected with hepatitis  C.

Due to the fact that hepatitis C virus can only be contracted by humans, it  was so far proving difficult to design a vaccine as animal trials are not an option.