People who are cured of hepatitis C live just about as long as those who never had the disease to begin with, according to research published today in the Journal of the American Medical Association.
The researchers followed 530 patients in the Netherlands with chronic hepatitis C infection for a median of 8.4 years. Of 454 patients for whom follow-up was completed, 192 achieved a cure. Of the patients who were cured, 13 died. However, 100 patients who weren’t cured died.
The research is important because it shows that even for patients whose hepatitis has advanced to the point of cirrhosis, or scarring of the liver, the risk of dying from liver cancer or other complications is low once they are cured.
Yet getting access to expensive new medications that can best achieve this cure, also known as a sustained virological response, remains a struggle.
New, once-daily oral medications can cure hepatitis C genotype 1 at a rate of 90 percent or more. But they cost more than $1,000 per pill. Even with only 12 weeks of treatment, private and public insurers have been reluctant to pay for the medications for people who are not yet seriously ill.
The Criminalization of Hepatitis C
A Michigan senator has introduced legislation in his statehouse making it a felony not to tell a sexual partner that you are infected with hepatitis C, moving to criminalize a disease many cannot afford to cure.
Sen. Roger Kahn, R-Saginaw, told Healthline that his legislation is necessary because the cost of medications to cure hepatitis C has the potential to cripple the state’s finances.
He said his move to criminalize hepatitis C is purely economic. “This came up because of the profound costs of treating hepatitis C,” he said, adding that it would cost Michigan $320 million just to treat its existing state prisoners who are infected.
“What we’re looking for is so that within the confines of the prison system, people will be tested upon entry so we know who’s got it,” he said. “If they have unprotected sex, they have a legal responsibility as well as a moral one to have their sexual partners … know that they have this issue.”
Hepatitis is a disease that progresses very slowly. Many people do not know they have it until they have been infected for two decades or longer.
That’s one of many concerns for Christine Rodriguez, public policy manager for the National Viral Hepatitis Roundtable in Washington, D.C., regarding Kahn’s legislation. She said that most people with hepatitis C don’t exhibit symptoms until many years after infection.
The Centers for Disease Control (CDC) has called for all baby boomers (people born between 1945 and 1965) to get tested for hepatitis C. Baby boomers are at risk of having been infected decades ago, before scientists discovered the disease or knew how it was transmitted. Many were infected through blood transfusions and organ transplants.
When Did Having Hepatitis C Become a Crime?
The Michigan legislation piggybacks on an existing law requiring people with HIV to inform sexual partners of their status. But unlike HIV, hepatitis C is seldom spread sexually, particularly among heterosexual couples, according to Dr. Naim Alkhouri, a pediatric gastroenterologist at Cleveland Clinic.
One study found that the virus is transmitted just once out of every 190,000 times a person has sex.
Sexual transmission is possible, however, and it occurs most often among men who have sex with men who are also infected with HIV. That led Rodriguez to wonder whether somebody infected with both HIV and hepatitis C could be charged twice under such a law. “It’s mind-boggling,” she told Healthline.
People who work on the front lines of the HIV epidemic have repeatedly said that testing is key to stopping the disease. Yet people in key populations, such as Hispanic men, may not trust the healthcare system and may not want to be stigmatized by family or friends for having HIV or even being tested.
“There’s already so much stigma around hepatitis C. And we have seen with the HIV criminalization laws, there already have been studies that say these laws discourage testing,” Rodriguez said.
“This is a violation of people’s human rights,” said Amy Nunn, executive director of the Rhode Island Public Health Institute and an expert on HIV and hepatitis C outreach. She told Healthline that Kahn’s proposed legislation is “stigma and discrimination when we should be encouraging people to get tested and treated.”
Rodriguez said Michigan’s is the first proposed law she has heard of aimed at criminalizing hepatitis C. However, last month, an Iowa woman with hepatitis C was charged with a misdemeanor after splattering a nurse’s face with her blood, according to the Iowa City Press-Citizen. The law the woman was charged with violating protects healthcare workers.
Rodriguez said several states have laws criminalizing the spread of sexually transmitted diseases and other infections, to varying degrees.
The trend in recent years has been to reverse or soften existing laws that can send people with HIV to jail for infecting others. Iowa led the charge back in February, and legislation has been introduced in Congress that would pressure other states to follow suit. New antiretroviral treatments for HIV make transmission far less likely, and revised laws reflect the fact that the public is better educated about HIV transmission as well.
“This takes us back,” Nunn said of the Michigan legislation. “But politically this is unwise, too, because baby boomers are the most heavily impacted by this and also are the most likely to vote.”