New Zealand needs to find the missing 25,000 if it wants to eradicate hepatitis C, writes Ian Breeze.
The year 1989 was an eventful one: the Berlin Wall came down, Tim Berners-Lee created the World Wide Web, and a deadly disease was reclassified and renamed.
This was viral hepatitis C erstwhile classified "non A non B hepatitis".
This infectious disease has eclipsed HIV/Aids, Tb, and malaria as the global number one killer amongst infective diseases, affecting up to 15% of the population in some regions.
An estimated 140-170 million are affected globally, including 50,000 in New Zealand, half of whom are unaware they have the disease. It has a high incidence in prisons as it can be spread by IV drug use and tattooing. Fortunately, Maori and other Asian diaspora have a degree of innate immunity. Prior to 1992 in New Zealand it could be contracted through blood transfusion.
Hepatitis C is a destructive disease. In New Zealand, it is the leading cause of frequently fatal primary liver cancer which develops in 3-5% per annum of hepatitis C infected.
Cirrhosis develops in 20-25%: Hepatitis C cirrhosis is now the commonest indication for liver transplant in New Zealand.
Hepatitis C also affects other organs — the brain, heart, kidneys, pancreas thyroid, lymph nodes and skin. Its manifestation include tiredness and depression, coronary heart disease, renal failure, diabetes and lymphoma. As a result, hepatitis C sufferers’ life expectancy is dramatically reduced by 18 years on average.
The efficacy of treatment has advanced. It is not possible to prevent hepatitis C by vaccination because the virus responsible mutates readily.
In the past treatment was unsatisfactory as Interferon was used, was often non-curative and had nasty flu-like side effects that were accompanied by a 1% suicide rate.
But now with development of breakthrough new anti-viral medications Ribavirin, Ledipasvir/Sofosbuvi, whose availability is funded by the New Zealand Ministry of Health, the outlook has radically improved.
This treatment is remarkably user-friendly.
The aim is for it to be prescribed in the community by general practitioners as a 12-week course of once-daily tablets.
The medications have no side effects and hence no monitoring is required during treatment.
Cure is established by a blood test months after treatment and there is 99% cure rate.
There is now realistic optimism that globally this disease will eventually be eliminated, as has happened with smallpox, and is happening with guinea worm infestation and polio.
It is axiomatic that to achieve this there needs to be full uptake of this treatment.
Australia is well advanced towards this goal, having identified 90% of those infected.
In contrast, in New Zealand, only 50% of those infected have been identified, meaning we have 25,000 who are unaware they have hepatitis C. To connect with these, revelations of this treatment breakthrough must "go viral!".
- Ian Breeze is a retired surgeon living in Dunedin.
