Hepatitis C, a disease that affects at least 5 million Americans, may be growing at a greater rate than reported as a “silent epidemic” of the virus spreads among younger people, according to a New York epidemiologist.
Inadequate U.S. government funding for prevention, treatment and research have contributed to the growing public health problem, said Brian Edlin, a professor at the State University of New York Downstate College of Medicine in Brooklyn, in an editorial published today in the journal Nature.
Viral hepatitis will cause about 150,000 deaths in the U.S. in the next decade as the population of patients with the disease ages, Edlin wrote. Increased use of injected drugs among 15- to 25-year-olds has unleashed a new wave of hepatitis C among young people, he said. Injected drug users, the group most likely to have new infections, rarely experience symptoms after acquiring the liver disease and are therefore unlikely to seek medical care and report its transmission, Edlin said
“Hepatitis C has been sort of a quiet epidemic,” Edlin said in a telephone interview, calling in the editorial for “urgent investment” similar to moves against HIV. “There hasn’t been the political pressure exerted to garner the necessary support for resources to be committed to it.”
The Centers for Disease Control and Prevention estimates there are 20 new infections for each case reported to its surveillance system, he wrote. About 18,000 people may be newly infected annually, about one person every 30 minutes, the CDC estimates suggest.
“It could be double that or 10 times that and we just don’t know,” Edlin said, citing government surveillance systems that don’t account for “disenfranchised” populations such as homeless people and prisoners. “We have no way of knowing how many of these infections are occurring.”
In its action plan published this month on viral hepatitis, the U.S. Department of Health and Human Services didn’t include an intention to increase funding for the disease, a necessary action to limit its spread, Edlin said.
The action plan “will offer an unprecedented opportunity to provide Americans, particularly those in vulnerable and underserved populations, with improved viral hepatitis prevention, care, and treatment services,” said Howard K. Koh, assistant secretary for health at HHS. “However, the federal government cannot do this alone. The prevention, care, and treatment of viral hepatitis will require leadership at all levels of government and full engagement of community-based organizations and the private sector to effectively address the extraordinary challenges we face with this silent epidemic.”
The U.S. should advocate providing hepatitis C testing wherever HIV tests are available, increase prevention efforts such as needle-exchange facilities and counseling, and prioritize research into therapies to improve care, Edlin said. The disease usually spreads through contact with infected blood. At least half of patients with hepatitis C could be cured with a course of therapy over six to 12 months, with new drugs expected to be more effective, he said.
This month, Merck & Co., of Whitehouse Station, New Jersey, won approval for the first hepatitis C drug in almost a decade, followed by clearance for another new medicine from Vertex Pharmaceuticals Inc., based in Cambridge, Massachusetts. A drug cocktail that has been the standard hepatitis C therapy for the last decade requires 48 weeks of treatment and fails in about half of patients. Clinical trials showed the new drugs cured more patients in less time when used with approved treatments.
Government organizations should bring the same focus to hepatitis C as they brought to the fight against HIV, Edlin said. He estimated the CDC allocated less than $10 million each for hepatitis C and B in its 2010 prevention budget, compared with $728 million for HIV, even though five times as many people are infected with hepatitis C as with HIV, according to his editorial.
“The United States launched a vibrant response to the HIV/AIDS epidemic and made great advances in surveillance, prevention, care and treatment by investing in research and services in these areas,” he wrote. “A timely, proportionate response to HCV will require leadership and resources. Nothing less will mitigate the extraordinary toll that viral hepatitis could take on the public’s health and on the health-care system.”