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Wed, Nov. 13

A different approach: High price of hepatitis C cure pushes health experts to promote prevention

Courtesy<br>Health Educator Frankie Reynols giving one of her prevention-focused presentations

Courtesy<br>Health Educator Frankie Reynols giving one of her prevention-focused presentations

Hepatitis C is a "silent disease" as symptoms are often vague, fatigue-or flu-like, and can take decades to manifest themselves.

The repercussions of the illness, though, can be severe.

Left undiagnosed and untreated, hepatitis C can cause irrevocable liver disease or cancer such that liver transplant is the only patient option, according to local doctors and health professionals.

Nationally, 3.5 million people are infected with the virus, with hepatitis C the leading cause of liver cancer and liver transplants in the United States, according to state and national health statistics.

The upside of this blood-to-blood transmitted disease is it is 100 percent preventable with proper education to halt sharing of needles and other injectable drug equipment. For anyone who may have contracted the disease years ago, there are now rapid screening tests that can deliver results in 20 minutes and new medications able to eradicate the virus and cure the disease.

The downside: the new drugs are expensive - a 12-week course of treatment can cost as much as $100,000 with insurance companies varying on coverage stipulations - and by the time the disease is detected the liver damage could be beyond repair, health professionals advise.

That is why Yavapai County Community Health Services Health Educator Frankie Reynolds is targeting the area's high-risk populations, holding seminars at recovery centers for drug addicts, homeless shelters, and college campuses, with a strong prevention message. She, too, offers some general education workshops.

Through a pilot educational program, Reynolds is teaching people how to avoid the virus spread through blood-to-blood transfer virus with hygiene habits that limit infection; unlike the HIV virus it is not a sexually transmitted disease. Sharing intravenous drug needles, as well as straws or pipes to snort drugs, is the highest risk factor, as is non-professional tattooing where injection equipment is not sterilized, or needles are reused between customers, she said.

Statistics indicate 1 out of 3 prisoners in this nation is infected with the hepatitis C virus, most often due to shared needles either for drug use or tattoos, Reynolds said.

Local gastroenterologist Dr. Richard Pleva, with more than two decades of experience in the diagnosis and treatment of this disease, said the testing recommendation is for all adults born between 1945 and 1965. In addition to IV drug users, Pleva said anyone who may have had a blood transfusion prior to 1992 is advised to be tested.

Pleva reiterated that symptoms are often so mild in the early stages they go undetected until the virus has killed off liver cells, or cirrhosis has already occurred. He said this virus does not affect other organs.

Alcohol consumption can also exacerbate the disease, Pleva said.

The arrival in the last year of medications that can cure patients of the disease is a major medical advance, Pleva said. Patients eligible for the new medications can expect a complete recovery, and with far fewer side effects than prior treatment protocols, Pleva said.

"I remember when I had to tell patients their cure rate was 50 percent," Pleva said.

The expense of the medications, though, has prompted issues over insurance coverage and eligibility, Pleva and Reynolds said.

In some cases, Pleva said insurance companies may be reluctant to treat someone in the early stages of the disease, preferring to limit coverage to those who are in more advanced stages. Others may impose lifestyle restrictions, such as drug sobriety for a certain length of time, Reynolds said.

When it comes to patient health, Pleva said he will always be an advocate for the treatment that will give the best results, be that with an insurance carrier or drug manufacturer. And though someone can live with the disease without significant impact he would prefer to

start treatment sooner rather than later.

To that end, State and local health educators see their job as limiting the need to advocate for medication. They would rather help people avoid infection in the first place.

"Sometimes cures can make us lazy," Reynolds said. "We think we don't have to change our behavior. We don't want to promote that message at all. Just because something is curable doesn't mean you want to get it."

Follow Nanci Hutson on Twitter @HutsonNanci. Reach her at 928-445-3333 ext. 2041 or 928-642-6809

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