Fewer Australians are dying from hepatitis C, but thousands are still missing out on treatment

Source: ABC News - Health Author: Olivia Willis

The number of Australians dying from liver failure and liver cancer related to hepatitis C has dropped by 20 per cent in just two years, according to preliminary data released today by The Kirby Institute.

It follows the introduction of highly effective, low-cost curative drugs to the Pharmaceutical Benefits Scheme (PBS) in 2016.

"This decline reflects the high uptake of direct-acting antiviral therapies among people with hepatitis C, particularly those with more advanced liver disease," said Greg Dore from the Kirby Institute.

"Since 2016, around 60,000 Australians have been treated with the highly curative therapies, and now for the first time, we are seeing fewer people dying of hepatitis C-related causes."

The data also showed the prevalence of hepatitis C infection among people who currently inject drugs had declined from 43 per cent in 2015 to 25 per cent in 2017.

"In terms of trying to control the epidemic, that is an enormous stride forward," Professor Dore said.

It is estimated, however, that 170,000 people in Australia are still living with chronic hepatitis C.

And, recent data shows, while the uptake of life-saving antiviral therapies was strong initially, there are now fewer than half as many people accessing the drugs as there were in 2016.

Hepatitis Australia's chief executive officer Helen Tyrrell said the recent drop in treatment uptake was "a real concern" and suggested many people remained unaware of the benefits or availability of new treatments.

"It is a tragedy that hundreds of thousands of Australians are missing out on life-saving therapies which can cure hepatitis C in a matter of weeks … when these cures are readily available with a prescription from their GP," Ms Tyrrell said.

What is hep C?

  • Hepatitis C is a blood-borne virus that attacks the liver. It is spread by contact with infected blood.
  • The symptoms of chronic hepatitis C often take years to emerge, meaning liver damage can 'silently progress' for some time.
  • Left untreated, hepatitis C can lead to cirrhosis (scarring of the liver), liver cancer and liver failure — and can be fatal.
  • In Australia, hepatitis C is most commonly spread through the sharing of unsterile drug injecting equipment.

New treatments 95pc effective

While hepatitis C treatments have been available for some time, previous therapies were "very long", "very gruelling" and "not all that effective", Ms Tyrrell said.

"What changed in March 2016 was some fantastic new cures became available. It was a real revolution when the Government agreed to put them on the PBS for everyone in Australia," she said.

The new treatments, which consist of daily tablets taken for approximately eight to 12 weeks, are generally well-tolerated and cure hepatitis C in 95 per cent of people.

Australia leads world in hepatitis C treatment

Australia is leading world in hepatitis C treatment, but the virus remains more prevalent in Aboriginal and Torres Strait Islander people.

Prior to being listed on the PBS, the drugs cost upwards of $20,000. They now cost less than $40 and can be prescribed by general practitioners — removing the need for specialist care.

"Being able to access these treatments through a GP is fantastic because it opens up the ability for people to come forward if they are a bit reticent because of the stigma," Ms Tyrrell said.

Australia is one of the only countries in the world to offer hepatitis C treatments at low cost, and without restrictions based on a person's stage of liver disease or injecting drug use behaviours, said Professor Dore.

"Australia's done an amazing job over the first two years … but only 30 per cent of people living with hepatitis C in Australia have been treated, so we need to continue to raise awareness about these life-saving treatments," he said.

Reaching marginalised communities

Professor Dore said for many people, a diagnosis of hepatitis C was often compounded by a complex set of health and social problems.

Hepatitis C disproportionately affects Aboriginal and Torres Strait Islander people, people who inject drugs, and people who are incarcerated.

"Some people might be homeless, some might have major mental health issues, some may not be injecting but they're on the margins — so they're not being adequately reached," Professor Dore said.

"That's why we need more innovative strategies to reach populations that might be more marginalised."

You could be at risk if:

  • You've been tattooed or had a piercing with unsterilised equipment
  • You've had an unsterile medical procedures or vaccination, particularly in countries with high rates
  • You've had a needle-stick injury
  • You've shared injecting drug equipment, including tourniquets, spoons and needles

A lack of awareness on the part of both patients and healthcare professionals has also led to low levels of treatment uptake in some parts of the community, Ms Tyrrell said.

"Many people may still not be aware of the new treatments. People who were diagnosed 20 or 30 years ago — when there really weren't any treatments available — may have been told to just go home and not worry about it," she said.

"Then you've got people who just aren't prioritising their treatment right now because they have no symptoms, and that's really dangerous … because often symptoms don't develop until quite serious complications occur."

In addition to raising community awareness, Ms Tyrrell said it was important for GPs to prioritise hepatitis C testing and treatment and to "start conversations with people they know may be at risk".

Stigma persists

Sydney man Grenville Rose contracted hepatitis C in the late 1970s and lived with the virus for almost 40 years, before being successfully treated with the new, highly curative oral therapies in 2015.

"I've been lucky to have the support of friends and family, but that's certainly not a universal experience for people with hepatitis C," he said.

Grenville said many people faced stigma and discrimination when disclosing or discussing their illness with family, friends or healthcare professionals.

"I've heard some really awful stories," he said.

"I once sat in front of a GP … she looked me in the face and said she really hated junkies and that they were a waste of space."

Ms Tyrrell said such stigma continued to be a significant barrier to people seeking treatment today.

"It is really disappointing sometimes that you get those attitudes," she said.

"Hep C is a health condition like any other. It doesn't matter how you got it — the important thing is that people are cured."

Australia on track to meet WHO targets

Despite the recent drop in treatment uptake, Professor Dore said Australia was in a good position to meet World Health Organisation elimination targets — to reduce hepatitis C deaths by 65 per cent and new infections by 80 per cent before 2030.

"We are somewhat concerned that things have declined in 2018 … but we are on track to probably treat 15,000 to 17,000 people this year," he said.

"There's no doubt the more people we treat, the faster the uptake is — particularly in those high-risk populations — the quicker we'll get to those elimination goals."

In July, the Federal Government announced $1 million in funding to "continue education and awareness activities" to improve hepatitis C testing and treatment uptake.