A surge in hepatitis C registrations during the 2010-2013 outbreak, and a link between thousands of new hepatitis C registrants and liver transplants, suggests widespread misuse of medication during that time may have led to a rise in hepatitis C in the US, a new study has found.
During the second half of the 21st century, new hepatitis C patients increasingly received long-acting cocktail-drug treatment, a type of treatment more commonly prescribed to alcoholic liver transplant patients, the study found. The pace of hepatitis C registration among liver transplant recipients increased from 5,000 patients in 2002 to over 66,000 in 2010— a 246% increase.
“While hepatitis C treatment and frequency of procedures have increased dramatically, whether or not treatment is safe and effective in the general population remains an unresolved question,” the study’s lead author, Louise M. McKendry, Ph.D., of Baylor College of Medicine in Houston, said in a statement. “This study shines a spotlight on patients who take more long-acting drugs, and at what cost.”
McKendry and her colleagues analyzed data from the United Network for Organ Sharing (UNOS), a national organ procurement organization, which sets transplant policy and oversees organ matching and procurement. They looked at liver registry data that preceded and after 2010, when Purdue Pharma began offering a long-acting, cocktail-drug regimen to chronic hepatitis C patients.
The newly introduced tablets typically stay in the body for six months, requiring two more months of treatment to cure hepatitis C. The dosage is changed for every patient. Sometimes the newer medication reverses the virus’s effect, and many patients will simply need to start treatment again.
After starting a long-acting cocktail therapy, the proportion of liver transplant patients who were new hepatitis C registrants increased during the 2010-2013 epidemic. “Treatment with long-acting drugs has been very popular among liver transplant recipients due to the potential for curing hepatitis C,” McKendry said. “This treatment has an attractive safety profile for heavy alcoholics.”
During the 2014-2016 pandemic, liver transplant registrants increased steadily—from more than 43,000 new patients to 64,414 — starting in 2012 and continued after the initial spike, the study found. Starting in the 2008-2009 pandemic, liver transplant registrants saw an increase in the proportion of hepatitis C registrants; the proportion of those new patients who were heavy alcoholics jumped from 9% in 2002 to 15% in 2010.
The American Association for the Study of Liver Diseases reports that the rate of liver cancer is 60% higher in hepatitis C patients than in non-hepatitis C patients. The prevalence of chronic hepatitis C is 1.2% of the general population, according to McKendry. And during the 2014-2015 pandemic, chronic hepatitis C was diagnosed in 3.2% of heavy alcoholic drinkers, the study found.
The study, published in the journal BMC Medicine, was funded by the National Institutes of Health.
The CDC considers hepatitis C a disease of poverty and low-income patients are more at risk for not receiving care. Treatment could cost more than $94,000 over 12 weeks, according to the group. While the new medication regimen was approved by the FDA in 2012, the first patient experienced serious side effects just two months later. The FDA restricted the new cocktail to those who had not previously been treated for chronic hepatitis C, while also noting that the symptoms of hepatitis C can last years.
According to the Centers for Disease Control and Prevention, nearly 2.7 million people in the United States have chronic hepatitis C infection and 45% of them are unaware of it. Because of the fact that the virus can remain dormant in the body for many years and, because of its ability to take more than one form, it can also thrive outside the liver for several years.
Get more coverage in the Tablets to Make You Fat series, where PennLive Health & Fitness and Wellness expert Kim Langer is joining The Young Doctor’s Table to help you get the most from your medications and get a better handle on what they are doing to your body. Learn more about what’s new and available and follow the other doctors on Twitter and Facebook.
Written by Christian Baker