For some American Indians, cost of hepatitis C drugs put treatment out of reach

By Mallory Black / Native Health News Alliance

SAN DIEGO – Public health advocates say hepatitis C is too often left out of the conversation of health in Indian Country, pointing to rising HCV-related mortality rates among American Indians.

The virus, which attacks the liver causing inflammation, is more prevalent in American Indians than in all other racial and ethnic groups, according to Hepatitis Foundation International. Between 2011 and 2012, acute hepatitis C rates increased more than 86 percent for American Indians and Alaska Natives, according to the Centers for Disease Control and Prevention.

“For American Indians, there is a high prevalence of hepatitis C among baby boomers who contracted it years ago, but also in younger people who inject drugs,” says Jessica Leston, Clinical Programs Manager at the Northwest Portland Area Indian Health Board. “Clinicians are seeing it now all the time.”

Nationally, about one third of injection drug users under 30 are infected with HCV, according to the most recent surveys by the CDC.

The CDC also reports 75 percent of older, former injection drug users have chronic HCV, but don’t realize they’re infected because symptoms can take decades to develop.

A High Price For A Curable Disease

An advocate for Native health, Leston assists tribal clinics in the Northwest and Great Plains regions by helping build community awareness around hepatitis C as well as by providing access to medical specialists who can diagnose and treat the disease.

She says local clinicians know hepatitis C is an issue and want to do something about it, especially now that there’s a potential cure. With the introduction of new antiviral drugs, clinicians could presumably manage treatment.

However, that potential cure comes at a cost - over $1,000 per daily dose, or $96,000 for a full 12-week treatment.

Clinical studies of one of the drugs called Harvoni, approved by the U.S. Food and Drug Administration last year, have shown 9 out of 10 HCV patients were cured after 12 weeks of treatment, according to the drug’s manufacturer Gilead Sciences.

Hannabah Blue (Navajo), a project manager at the American Indian Public Health Resource Center at North Dakota State University, says many Native people need HCV treatment, yet the high price often puts the cure out of reach.

Financial assistance programs are available for patients to help lower the cost of the antiviral drugs. More information about patient assistance and eligibility can be found through the American Liver Foundation.

Left untreated, chronic hepatitis C can progress into liver failure and liver cancer. In Indian Country, chronic liver disease is the fifth leading cause of death.

American Indians are more likely to die from hepatitis C than other races and ethnicities, making it one of the most deadly diseases for Native people, according to Hepatitis Foundation International.

The foundation’s chief executive officer, Ivonne Cameron, says the epidemic of type 2 diabetes and alcohol abuse in Native communities often propels the progression of HCV infection.

“If you consume alcohol at a significant rate, that will further damage the liver and lead to faster progression of hepatitis C-related diseases like cirrhosis, liver cancer, and ultimately cause death,” Cameron says. “These risk factors contribute to the progression of the mortality of the disease.”

Currently there is no vaccine to prevent hepatitis C. An added challenge to combatting the spread of HCV is that many people haven’t been diagnosed, a problem not exclusive to Indian Country.

About 2.7 million Americans live with chronic hepatitis C, according to the CDC. However, citing statistics on the number of American Indians living with the disease is difficult because of the lack of accurate, comprehensive data.

The Stigma Attached To Hepatitis C

Health advocates agree that what has obscured the perception of HCV is its association with HIV, or human immunodeficiency virus, and its tie to injection drug use.

Both HCV and HIV are blood-borne viruses with similar risk factors, but Blue says HCV is much more transmission-resilient, surviving on “surfaces, needles and other equipment used for injection drugs for days.”

Transmission of HCV commonly occurs through sharing or reusing needles to inject drugs. Homemade tattoos and using unsterilized tools for body piercings are also risk factors.

Because of occupational exposures such as needle sticks, medical workers can be at increased risk for hepatitis C. Some patients were exposed to HCV via transfusion or other medical procedures that were done prior to 1992, the year a blood test for HCV was approved.

For most patients, the source to the virus is unknown.

“We shouldn’t have to wait for an outbreak of hepatitis C to work on preventing it,” Blue says. “Getting tested doesn’t seem urgent, but it is.”

© Native Health News Alliance This is the first in a series of hepatitis c stories produced by the Native Health News Alliance (NHNA), a partnership of the Native American Journalists Association (NAJA).

NHNA creates shared health coverage for American Indian communities at no cost. Registered users can download additional print, web and audio content at www.nativehealthnews.com and publish as is or add their own reporting, highlighting important issues within the local Native community. NHNA services are free to all those who think good journalism has a positive impact in the lives of all of our readers, listeners, and viewers.