This past year, many of us have been shaking our heads over a crisis in the hepatitis C world. The crisis is the sad fact that many insurers, including state Medicaid programs, are denying treatment to a substantial number of hepatitis C patients. If this issue is new to you, read Hepatitis C: Why We Aren’t Curing this Easy to Cure Disease. In short, patients are being denied treatment because health care is being rationed. Worse yet, it is being rationed without medical justification, since the HCV Guidelines state, “Evidence clearly supports treatment in all HCV-infected persons, except those with limited life expectancy (less than 12 months) due to non–liver-related comorbid conditions.”
This is a tragedy on many levels. Hepatitis C is curable. The treatment is now relatively safe. Cost is the main obstacle, and even that seems like a minor issue, given the opportunity to cure the disease. Another reason why this is tragic is because hep C is an infectious disease. Every untreated case of hepatitis C is a potential reservoir of future infections. And if ever there was a time that we need to do some big-time infection control, it is now.
In an alarming report released by the Centers for Disease Control and Prevention (CDC) four Appalachian states (Kentucky, Tennessee, Virginia, West Virginia) showed a 364 percent increase in the number of cases of new hepatitis C infections from 2006 to 2012 among persons aged ≤30 years. The majority were white, rural residents.
Similar increases are occurring in other areas of the country. Indiana is experiencing severe increases in hepatitis C and HIV infections, largely due to an increase in the use of opioids. The problem is so huge that Indiana governor Mike Pence temporarily suspended the ban on needle exchange programs in the state. In a similar, more proactive move, Louisville, Kentucky opened a needle exchange program this week.
Needle exchange programs are effective tools for combating viral hepatitis and HIV. However, when battling a virus, it is best to attack it from all sides. Access to treatment is also a weapon that will stop further infections. What are we waiting for?