In people who inject drugs (PWID), late chronic HCV (hepatitis C virus) disease therapy can cause severe liver damage. Worldwide there is an estimated 12.7 million people who inject drugs. Hepatitis C virus is a blood-borne viral infection estimated to affect 160 million people worldwide. HCV can contribute to cirrhosis of the liver, and if left untreated chronic liver disease will occur in 60 to 70 percent of patients; five to 20 percent will live with cirrhosis and up to five percent will die from it.
The latest research from New York University suggests that delayed HCV treatment can contribute to severe liver damage, which can ultimately lead to death.
Delaying HCV therapy can lead to advanced liver diseases
Drug injection is the primary way to contract HCV within the U.S., making it a common disease among people who inject drugs. Estimates reveal that 50 to 80 percent of PWID are chronically infected. Less than five percent of PWID receive treatment for their HCV.
For the research, 21 studies were examined with over 8500 persons who inject drugs.
Principal investigator, Holly Hagan, said, “Understanding HCV disease progression rates among people who inject drugs (PWID) is important to setting policy to expand access to detection, diagnosis and treatment, and in forecasting the burden of disease. In this study we synthesized existing data on the natural history of HCV among PWID, including fibrosis progression rates and the incidence of compensated cirrhosis, decompensated cirrhosis, and hepatocellular carcinoma.”
“Based on our analysis of fibrosis progression, PWID, on average, will have moderate liver fibrosis between 26 to 38 years after HCV infection and will develop cirrhosis within 34 to 46 years,” said Dr. Hagan. “In the course of the disease progression, cirrhosis may lead to HCC, the prognosis for which is extremely poor – the median length of survival is approximately 12 to 15 months. Since PWID tend to be infected at an early age, they are likely to develop HCC in mid- to late-adulthood, resulting in losses of individuals in their most productive period of life.”
The researchers believe their findings reveal many benefits associated with early treatment of HCV and can eventually result in a cure. Unfortunately, treatment like this is often expensive and may not even be available to PWID. Furthermore, many insurers do not cover such early preventative treatment, not until the illness has progressed much further.
The team is hopeful that by creating a better understanding of the rates of HCV in PWID they can create policy change among insurers. Dr. Hagan concluded, “Unfortunately, the restrictions on HCV treatment force us to identify other ways to slow disease progression.”
What is chronic hepatitis C?
Hepatitis is a condition that causes inflammation of the liver. There are three different types, including hepatitis A, hepatitis B and hepatitis C. Chronic hepatitis C is a lifelong illness that affects the liver. On the other hand, there is also acute hepatitis C, which is a short-term illness starting within the first six month of exposure to the illness. For some patients, acute hepatitis C can lead to chronic hepatitis C.
The difference between hepatitis A, B and C is that different viruses cause them. Although they can share similar symptoms, they all use different modes of transmission and affect the liver differently. Currently there are vaccines for both hepatitis A and B but none are available for hepatitis C.
An estimated 2.7 million Americans are infected with hepatitis C, but many do not know of their diagnosis because they do not show symptoms or feel sick. The rate of chronic hepatitis C is around 75 to 80 percent in those who begin with acute hepatitis C.
Transmission of chronic hepatitis C in PWID
Hepatitis C is common among people who inject drugs. Transmission of HCV can occur through blood transfusions from unscreened donors, unsafe therapeutic injections and many other health-care procedures. Among people who inject drugs, transmission of HCV occurs from the sharing of needles.
Because HCV is so resilient, it is able to stay alive on drug equipment weeks after exposure. Among people who inject drugs, rates of HCV are higher than HIV.
Prevention and treatment of HCV infection for PWID
When treatment is required it typically involves injection on a weekly basis for up to 48 weeks. New antiviral treatments have recently been developed which have shown to be far more effective than the older method of injections over 48 weeks. These direct antiviral agents (DAA) are safer to use and consist of less adverse effects. Furthermore, the treatment is shorter – only lasting 12 weeks. The problem is initial costs of such treatments are expensive, making it unavailable to lower-income individuals.
The best form of treatment for HCV is prevention – not contracting it in the first place. Because there are no vaccines for HCV, it’s important to lower your risk of encountering the virus. Primary prevention methods include:
- Hand washing
- Safe handling and disposal of sharp objects and needles
- Harm-reduction services for PWID
- Testing donated blood for hepatitis B, C, syphilis and HIV
- Training health personnel
- Promotion and education of the use of condoms
Secondary and tertiary prevention techniques include:
- Education and counseling about care and treatment options
- Immunization of hepatitis A and B to prevent co-infection
- Early and appropriate medical management
- Regular monitoring for early signs of liver disease
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