Eliminating Hepatitis C

What we understand about viruses has changed immensely over my 35 years as a nurse. I was taught that we couldn’t cure viruses because they change too rapidly—think of the flu—and the best we could do was immunize against some of them. During the course of my career, we have done so much better than that, and this gives me hope and excitement for the future.  

Viruses, not all bad news 

We used to call people still living with an HIV (Human Immunodeficiency Virus) infection after 10 years  “long-term survivors.” Today, people infected with the virus who start and continue treatments have a normal life expectancy.  People infected with HIV can now take medications to bring their viral load down so low that they can prevent spreading HIV to a partner. Medications can even be prescribed that prevent HIV infection from unprotected anal sex.

Since a viral link has been made between HPV (Human Papillomavirus) and some cancers, cervical cancer has evolved from something people die from, to something people can immunize against. While HPV continues to show up in cervical, anal, and even head and neck cancers, vaccines for certain types of HPV  are now widely available.

We’ve also made great strides with Hepatitis C.  At one time, it was a virus we didn’t know existed. Then, it became one we could identify and test for, but couldn’t really treat. Today, we can actually cure it—at least 97 per cent of the time. 

Hepatitis C

Hepatitis C (HCV) is a type of virus that attacks the liver. “Hep” means liver, and “itis” means inflamed. There are five strains of hepatitis viruses, with A, B, and C being the most commonly known. While they each affect the liver, they differ in how they are spread, the symptoms they cause, and the treatments they require.     

Hepatitis C lives in blood and is transmitted through blood to blood contact. Only about 30 per cent of people infected with HCV will naturally clear it. Most people who catch the virus will keep it and be capable of passing it on to others. 

We did not know Hepatitis C existed when I was in nursing school in the 1980s. There was talk of a third Hepatitis infection associated with blood transfusions, then called non-A non-B Hepatitis. Since it couldn’t be identified—that didn’t happen until 1989—there was no test for it. As a result, thousands of Canadians were infected with Hepatitis C from the national blood supply while getting blood transfusions and blood products. In Canada, we didn’t start screening the blood supply for HCV until 1992. 

Nowadays, our blood supply is screened, so most HCV infections today come from smoking, injecting, or snorting street drugs like OxyContin, Percocet, Dilaudid, fentanyl, morphine, methamphetamines, cocaine, or heroin. They’re spread by sharing equipment, including needles, water, cookers, filters, pipes, straws, or bills. 

During the HIV epidemic in the 1990s, I was working in Vancouver with the street nurse program doing outreach in the downtown eastside. It was during that period that we were able to begin testing people who were using needle drugs for HIV; if they were interested, we could test for HCV as well. 

Most people we tested who were using needle drugs already had it. It was so prevalent that eventually, many of them declined testing. The tests we used could only detect the presence of HCV antibodies anyway, and not viral load, so there was no way to differentiate between a past or present infection. Some people with Hepatitis C infections can clear it on their own, but more than half do not. Back then, there was no treatment to offer them. HCV continued to spread. We still had a lot to learn about the virus.

A ‘hearty’ virus

HCV is a very ‘hearty’ virus. It can live up to almost a month in a warm, moist needle. It can live in shared waters for dissolving drugs and shared filters for drawing up. HCV can even live in dried blood on a snorter or straw and be passed from one person to another through exposed and inflamed nasal tissue, or nasal erosion. Heat won’t kill HCV so it can also live on a crack pipe or in a cooker. Many of our strategies for preventing the spread of a fragile virus like HIV do not work for a hearty virus like HCV.  

In addition to the heartiness of the virus, it is also persistent. Most people who get HCV do not naturally clear it like they do with Hepatitis A or B.  Between 75-80 per cent of people with HCV remain infectious; the virus will continue to grow in the liver and they will to be able to pass it on to others. Somebody can feel well and have no symptoms, and still be infected with HCV. Long term infection with HCV can lead to serious liver disease like cirrhosis and liver cancer.

The first treatments for HCV came out in the late 1990s. They were interferon-based treatments that activated the immune system. They involved eight to 12 months of medications, had a multitude of side effects, and worked less than half the time. They also required complicated treatment regiments and a multitude of gastroenterologist specialist appointments. The drugs were eventually discontinued. HCV continued to spread, until 2016 when a new antiviral treatment was discovered.

A treatment that works

The treatments for HCV are so straightforward now that curing it has moved out of the gastroenterologist’s office and into primary care. A primary care provider can treat most healthy people with HCV, saving the gastroenterologist appointment for people with more complex medical issues and comorbidities.  

For the past eight years, HCV treatments involve antiviral medications in pill form that are taken daily for eight to 12 weeks. The people I’ve treated report few, if any, side effects. The medications have a 97 per cent cure rate for HCV.

The drugs are so good that the World Health Organization believes we can eliminate HCV globally by 2030. Canada has signed on to the WHO’s Global Hepatitis Health Sector Strategy. Newfoundland and Labrador is on track. The drugs used to treat HCV are covered by MCP and private insurance, which makes them accessible.

The only way to find out if you have HCV is with a blood test to check for the virus. It is suggested that anyone who uses or has snorted, injected, or inhaled drugs get tested. As well, a one-time HCV test for anyone over the age of 45 is encouraged. 

During my nursing career, HCV has gone from a virus we couldn’t recognize, to one we could identify but not cure, to now being curable. This, to me, is amazing and it makes me hopeful.

Testing is straightforward, and treatments are available. Let’s make Newfoundland and Labrador Hepatitis C free. If you’re not sure where to test or get treatment, see a health care provider, or reach out to me here at The Indy and I’ll steer you in the right direction.