New hep C campaign to target boomers, IV drug users

A new state-run campaign will heavily push screening for hepatitis C among baby boomers and intravenous drug users.

Set to launch in mid-October, the Delaware Division of Public Health program aims to reach out to health care providers, especially primary care doctors and substance abuse clinicians, to educate them on whom to screen and how the disease is transmitted.

A story in The News Journal this month detailed how the state’s wave of heroin addiction is driving an explosion of hepatitis C cases among intravenous drug users and the barriers they face to get expensive medication.

Despite that, Delaware is one of seven states that does not consistently report case numbers back to the Centers for Disease Control and Prevention, and officials acknowledge that cases are significantly under-reported.

“The campaign will help us to have better numbers because more people will be screened and more cases will be reported,” said Dr. Karyl Rattay, director of the Delaware Division of Public Health.

“Delaware is not alone in that we are not reporting to the CDC ... but it is very important to us that we are able in a very short amount of time to have much more accurate numbers and quality.”

Hepatitis C, a blood-borne disease, is most easily spread through intravenous drug use, but can be contracted in other ways from contaminated blood.

It’s a viral infection with few early symptoms. People with this infection progressively develop liver scarring, liver cancer or total failure of the organ.

Dr. Michael Brooks, a gastroenterologist with GI Specialists of Delaware who treats about 20 percent of his patients for hepatitis C, is extremely supportive of the state’s new initiative. It’s a very treatable disease now, he said.

But screening alone will not solve the problem, as people need access to treatment as well, he said.

The hepatitis C medication is extremely expensive; a 12-week regimen for the most effective direct-acting pharmaceutical treatments, Sovaldi and Harvoni, can cost up to $94,500.

Insurance companies also have strict requirements to approve it. Medicaid, for example, requires a patient to be diagnosed with late-stage cirrhosis or liver scarring in order to OK the medication.

“I think it’s a great push and I do think the primary care doctors should be testing, but the question is going to be are the state and the insurance companies going to be prepared for the results,” Brooks said.

“There’s negotiations that the state can do with the pharmaceutical companies.”

Rattay acknowledged that resolving cost issues with treatment is “a bit more complicated.”

The division needs to increase internal infrastructure and staffing to get a handle on the hepatitis C problem, Rattay said, adding that every positive test reported to the division requires an investigation.

About 33 percent of younger IV drug users are infected with hepatitis C, according to national data. However, the baby boomer generation is one of two-fold concern. Approximately 70 to 90 percent of boomers are at risk of being infected with hepatitis C.

The CDC encourages people born between 1945 and 1965 to speak to their doctor about getting tested for hepatitis C, because they could be at risk for contracting the infection through contaminated blood transfusions and organ transplants. Before 1992, there were no stringent regulations on the blood supply in medical settings.

Doctors could not confirm how Bob Ryan, 59, contracted hepatitis C – and neither could Bob.

He did not have a history of intravenous drug use nor did he receive a blood transfusion or transplant before his official diagnosis in the 1990s.

“I didn’t want to tell anybody I had it for a long time,” said Bob, an engineer who lives in Wilmington. He’s lived with the disease for over 20 years.

“There’s no telling. I was obviously exposed somewhere. Sometimes it is just unknown.”

After his diagnosis, specialists found that his liver enzyme levels were high, which signifies inflammation or damage to the liver cells.

He tried interferon, a treatment that can be effective, but has intense side effects, but that failed to treat the HepC.

After a series of failed treatments in 2013, Bob’s liver damage hit a peak – he was diagnosed with liver cancer and needed a transplant.

Luckily, he was successful in getting one. He received a transplant from a deceased donor who was hepatitis C-positive, and in a year’s time was ready to try another treatment to get rid of the infection.

No treatment had worked until he tried Harvoni; on his sixth week of the treatment his body had been clear of the virus. But because so many treatment plans failed to work for him, he had to undergo a full six months of treatment.

People need to get tested because often symptoms don’t show until it’s too late, said his wife, Susan. Not just drug users can get this disease, she added, and it can surprise anyone. She hopes that with the testing more people will not have to go through what her husband did.

“We’re just regular people. We pay our bills. We take care of ourselves,” she said.

Jen Rini can be reached at (302) 324-2386 or jrini@delawareonline.com. Follow @JenRini on Twitter.