B.C. medical researchers offer treatment by prevention for hepatitis C

published on December 31, 2014 by Sunny Dhillon, in The Globe and Mail

Nominator: Julio Montaner is a giant in the world of HIV and AIDS research. Dr. Montaner – director of the B.C. Centre for Excellence in HIV/AIDS and past president of the International AIDS Society – pioneered the highly active anti-retroviral therapy (HAART) that has become the international standard of care. Dr. Montaner was last week named to the Order of Canada. He was honoured by the province of B.C. last month.

Innovation: While stressing there is still work to be done when it comes to fighting HIV/AIDS – other provinces have not seen the same progress as B.C., and rates remain high in some First Nations communities – Dr. Montaner said one area he is watching is treatment of hepatitis C.

“I think one of the most exciting developments that is happening is the emergence of new treatment – highly effective, very simple, extremely well tolerated, but unfortunately very expensive – for hepatitis C.” - Julio Montaner, director of the B.C. Centre for Excellence in HIV/AIDS

Mel Krajden, medical head of hepatitis – clinical prevention services at the B.C. Centre for Disease Control, said between 70,000 and 80,000 British Columbians have hepatitis C, a chronic liver disease.

That is in comparison to the approximately 12,000 believed to have HIV.

Dr. Krajden said in an interview that the new treatment involves a drug regimen lasting eight to 12 weeks.

He said the drugs could have a cure rate of 95 per cent, if not higher, offering hope of eliminating hepatitis C altogether.

A B.C. Ministry of Health spokeswoman said the province is considering whether to cover the hepatitis C treatment, which is known as Sovaldi.

The spokeswoman said the drug costs about $640 a pill, or between $55,000 and $110,000 a patient.

She said B.C. is reviewing the treatment and its benefits, and, with Ontario, is in discussions with the manufacturer to negotiate the best price.

“We recognize the potential this drug offers to some patients; however, we need to make sure that any decision we make balances what is affordable for the taxpayer,” she wrote in an e-mail.

The ministry spokeswoman added the province began paying for a hepatitis C drug called Galexos for some patients in late October. Those patients must be new to hepatitis C treatment, have failed with older treatments, or could not tolerate the side effects of older treatments. Patients covered for Galexos have genotype 1 hepatitis C, she said.

Dr. Krajden said people with hepatitis C split into four major groups. He said people who inject drugs represent the majority of new infections. Therefore, a “treatment as prevention” model – such as the one Dr. Montaner and his team use for HIV – could be suitable.

Treatment as prevention refers to the offer of widespread testing and immediate treatment for those who need it.

Dr. Krajden said the second major group is baby boomers, who could have been infected long ago and are unlikely to transmit the infection. Baby boomers make up at least two-thirds of those with hepatitis C in this province, he said. The third group is immigrants, most of whom were infected in their country of origin, and the fourth is aboriginal people, Dr. Krajden said.

While the cost of the emerging treatment is high, Dr. Krajden said hepatitis C has long faced another challenge, in that it lacks the kind of advocacy HIV has had.

“We have a curable illness and we have within our means the ability to create a course to eradicate hepatitis C over the coming decade. And, if we do so carefully, we will reduce transmission, we will reduce the costs and burden of disease, from liver disease to transplantation to cirrhosis, and from liver cancer,” he said.

“So if we can carefully offset existing costs, while treating people to make them better, you can create an elimination strategy. And I think we need to have the wherewithal to do that.”

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BC Centre for Excellence in HIV/AIDS

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B.C. medical researchers offer treatment by prevention for hepatitis C

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