Welcome and thank you for joining us for Beyond the Data.
I'm Dr. Phoebe Thorpe here today with Dr. John Ward, the Director
of the Division of Viral Hepatitis at CDC.
Thank you very much for joining us John.
It's nice to be here, Phoebe.
Great. Today we learned that there is a cure for Hepatitis C,
and it sounds like it's safer and easier
and cures more people.
What can you tell me about it?
Well, we've had a cure for Hepatitis C for many years,
but what's the good news is that we've had a big breakthrough
in the effectiveness of these drugs
and at the same time they've become safer
and easier to take as patients.
So, as a health care provider, what could I do
to help my patients who might have Hepatitis C?
First thing you can do is test the patients who are
at high risk for this infection.
Of the three million people infected with Hepatitis C
in the United States about three out of every four
of those are the so called "baby boom" generation, persons born
between 1945 and 1965.
Why is it so concentrated in that period?
Three of every four persons who have Hepatitis C were born
between 1945 and 1965.
Of all persons born between 1945 and 1965
about 3% have been infected with Hepatitis C,
which isn't quite a high prevalence for a viral infection
that can lead to liver cancer and premature mortality.
What do they need to do to get tested or screened?
Most people have a regular physician and when they go
in to see their clinician the next time they should ask
for a test for Hepatitis C. What does the testing involve?
So it is a blood test.
There's a rapid point of care test
that only requires a finger stick.
It takes about 20 minutes to get a result back.
And then is there more testing beyond just that rapid test?
So the first test tells you whether you've been exposed
or not by detecting the antibody that the body produces
when it comes in contact with an infectious disease
like Hepatitis C virus.
Then once infected that person has about a 70% likely hood
of remaining infected for life, unless they get treated.
This isn't a static problem, it's a dynamic problem.
Meaning new infections continue to occur.
So CDC is, you know, we have two goals for prevention.
We want to stop mortality from this virus and we want
to stop new infections.
And unfortunately,
new infections are rising in the United States.
What are the risks there that are making the number
of people exposed to Hepatitis C go up?
That's exactly right.
In the 90's the blood supply became very safe
through testing, health care settings became safer
through various interventions for patient safety
and even among injection drug users the transmission risk went
down in response to the HIV epidemic.
But, just in the last three
or four years we've seen a dramatic increase in the number
of new cases of Hepatitis C indeed
in the nation by the 50% increase.
In some states reporting a 200% increase
in the number of new cases.
And those are related to what?
What? That strongly and heavily related to a reemergence
of injection drug use.
Is there guidelines now if you hav..., if you are a person
who injects drugs and can't seem to kick the habit?
Are the guidelines for how often you should be tested
for Hepatitis C?
We recommend everybody get tested if they're drug user,
as to where the first order of business and that's not done
as well as we would like so there's a lot
of injection drug users who still are unaware
of their status one way or the other.
Because they are high risk we think they should be screened
about every year.
Now we have to learn how to use these new treatments that are
so safe, highly effective and, and, and, shorter acting
than the other medications in the past.
So half....
So, So half, half the length and no having to go into the doctor
to get an IV put in and have the medication put in
and have the medication put in in an IV form.
Right. Okay And you, and the new research suggests
that the treatment duration might be able
to be reduced to eight weeks.
The treatments were more complicated before but now
that they're easier and they also kind of sound
like they're working better.
We need to really correct those old impressions of the treatment
because we've entered into a new era of these,
that a lot of these barriers that you just highlighted
of side effects and duration of treatment are going away
and so those barriers are dropping and it's really coming
at a very, very important time for public health as we want
to reverse these increases in death, avert premature death.
We feel like we can save 120,000 lives
if we fully implement 120,000?
At least. Wow.
Some of the things that came up today also were cost.
And that's often the case when you have these breakthroughs
in medicine and these sort of first in class agents
in particular category they tend to be expensive.
I mean this is the first cure of a chronic viral infection
in the history of medicine, and so it's a, it's a,
it's a monumental event, a cure.
A cure. It's so nice to be able to say
that word, cure, it's a cure.
I agree, I agree, we have to get used to saying it.
But we still have to deal with the cost issue.
As a country, CDC as an agency doesn't have a role
in drug pricing or anything like that.
But what we try to do is, look at data,
examine the cost effectiveness of various interventions
and what our data tell us is that if someone is HCV infected
and has liver disease, it's very cost effective for the country
to treat that person, clear their infection
and lower their risk of cancer by 70% and their risk
of mortality by 50% and in so doing you're saving the cost
to the health system of caring
for those diseases down the road.
Down the road Okay, yeah And improve
that individual's quality of life Exactly,
and that's all public health reflective
and in the meantime the person gets
to be healthier and live longer.
Right. We don't want to lose site
of the benefits of treatment.
We can always bring those together
and examine them together.
And so I think that's what,
that's the role that CDC can play.
If they're cured they're not going to be able
to transmit it to other people.
Absolutely, and I think that hasn't really been brought
into the equation but it interrupts transmission...
it can interrupt transmission
so you're saving additional cost in that way too.
Thank you very much for joining us.
I enjoyed it.
And thank you very much for joining us for Beyond the Data;
we'll see you next month.
Thank you!