Over the years, we have all witnessed the dramatic and increasingly tragic effects that opioid use (and misuse) have had on people and communities all across the country.
As we work to swiftly and adequately respond to this crisis, there is an area where we’ve fallen short. More and more people affected by the opioid epidemic are being diagnosed with serious viral infections — HIV, hepatitis B and C — which, if left untreated, can be deadly. The most common of these is hepatitis C, which infects an estimated 3.5 million Americans, including some 21,000 West Virginians. In fact, West Virginia has the second-highest rate of acute (new) hep C infections in the nation.
Hep C infects the liver and, over time, can advance to cirrhosis, liver cancer and death, if an individual doesn’t receive treatment to cure the condition. Hep C is often called a “silent killer,” because individuals can live for many years without experiencing any symptoms and without knowing they are infected. The Centers for Disease Control and Prevention reports that between 2006 and 2012, there was a 364 percent jump in hep C infections throughout central Appalachia, including West Virginia. Hep C infections have surged in the region among those under the age of 30, and primarily among those who have turned to injection drug use as a result of the opioid crisis.
I have witnessed, firsthand, the devastating effects that hep C has had on our fellow West Virginians, particularly those who live in rural areas where health providers may be less familiar with diagnosing and managing the condition. While there is an urgent need for clinicians to diagnose and treat hep C all across our state, nowhere is that need more urgent than in the Southern coalfields, in places like McDowell, Mingo and Wyoming counties.
But this is not, nor does it have to be, a doom and gloom story.
The good news is that, unlike other chronic viral infections, there is a cure for hep C. But without making hep C screening a priority, we will not be able to diagnose and treat those West Virginians who are chronically infected. Hepatitis C is only transmitted from person to person, so curing someone not only improves their own health but also slows the spread of disease to others.
At some point in the future, it should be possible to eradicate the disease just as we have eradicated smallpox — a phenomenal public health accomplishment.
The task before us is to ramp up testing for hep C so we can find the people who need care before they develop cirrhosis, end-stage liver disease and liver cancer — costly and dire health outcomes that are preventable.
We also need to arm primary care providers with the knowledge of how to screen, diagnose and treat hepatitis C, as the development of curative medications is fairly recent. Curing hep C and managing people before and after curative therapy should be in the domain of what primary care providers can do.
There is a highly successful West Virginia University-based Hep C ECHO program, which is an online program to train and support primary care providers. Other training programs are in development.
In addition to screening and testing challenges, it is important that our politicians consider the policy hurdles that prevent those in need from being cured. Current restrictions on when a patient can receive treatment and which providers can treat a patient put the medical community and our efforts to gain control over this crisis at a serious disadvantage.
We also know that addressing hep C as early as possible makes sound economic sense. Approximately 80 percent of West Virginians who are infected with hep C will develop chronic disease. The average lifetime cost for caring for a hep C patient is estimated to exceed $205,000. If we are able to greatly expand screening, testing and getting patients cured before their condition worsens, this undoubtedly will allow us to greatly reduce the burden on our state’s health care system.
I recently participated in the launch of a new statewide program called HepConnect, which is funded by Gilead Sciences and administered through a multi-year and multi-million dollar grant to the Harm Reduction Coalition. This new effort plans to support West Virginia — and four other states — to address hepatitis C. HepConnect takes a partnership-based approach to finding ways to expand screening and linkage to care, support harm reduction and community education efforts and strengthen health care infrastructure to reduce hep C infection rates and assist those with getting the treatment they need.
Conquering hepatitis C will require policymakers, the medical community and advocates to come together to make ending West Virginia’s hep C epidemic a reality. Given how common hep C is in West Virginia, we must start with statewide screening so that we can finally understand how great the need truly is. From there, we can begin to put an end to this disease once and for all.
