For the first time, Rhode Island has one of the most complete pictures of the extent of the hepatitis C epidemic. More people are infected, and more are dying from the viral disease than previously known, finds a new study. But more people are also getting treated – and cured.
Hepatitis C is a virus that attacks the liver. Without treatment, it can cause cirrhosis, liver cancer, or other nasty complications. It’s also one of the most contagious viral diseases – spread by contact with infected blood. Sharing needles to inject drugs is one of the most common ways of contracting hepatitis C. And with injection drug use rates soaring here, researchers decided to conduct the first and most comprehensive study to date of hepatitis C in Rhode Island. Lead author, Brown University’s Rhode Island Institute for Public Health Director Doctor Amy Nunn.
"This study really represents an advance because it has a lot more local information," says Nunn. "It’s based on real world data about how many people may be affected."
Detailed information about new infections has been hard to come by. And unlike some other states, Rhode Island still has no systematic way of gathering information about hepatitis C, no centralized reporting mechanism. That means it’s been hard to get a handle on how big a problem the disease is. But Nunn and her colleague Rhode Island Department of Health infectious disease doctor Phillip Chan scoured multiple data sources for numbers – from health insurers and infectious disease testing labs, to community health centers and the Rhode Island Department of Corrections. What emerged was troubling, says Nunn. Previously, we had only a mathematical model projecting that two percent of Rhode Island’s population was infected.
“The data in this report suggest the disease burden is actually much greater," Nunn says. "Most of the health systems that conducted screening found that between four and seven percent of the people they screened had reactive antibody tests.”
Meaning they’d been infected by the hepatitis C virus.
What’s more, nearly 700 Rhode Islanders died from the disease over the past decade – the number steadily rising year over year. In fact, nationwide, more people die from hepatitis C than from HIV and nearly 50 other infectious diseases. Hospitalizations for hepatitis C have also shot up over the past 10 years, partly because symptoms are just now showing up in the most affected population: baby boomers. The health department’s Phillip Chan says that’s likely to continue.
“Hepatitis C is much more prevalent than other diseases like HIV, and really points out the need for increased testing across the state," says Chan. "We really encourage people, especially baby boomers, those are people born from 1945 to 1965, especially, to be tested at least once for hepatitis C, and people that have other ongoing risk factors.”
Like injecting drugs.
But younger Rhode Islanders may be increasingly affected too. Nunn and Chan believe that could be driven by rising rates of injection drug use and needle sharing among people in their 20s, 30s, and 40s. The researchers laid two maps side by side: one, the location of the diagnosis of hepatitis, the other, the location of the state’s opioid overdose deaths. And the maps nearly perfectly overlap. Hepatitis C diagnoses are highest in areas with the highest rates of opioid overdose deaths. In other words, says Nunn, hepatitis C is becoming the sister epidemic – or syndemic - to opioid addiction and overdose.
“But we think there’s a lot of public health opportunity to respond to these two epidemics concurrently, because they’re affecting the same people," says Nunn, "and we also know, geographically, where we need to target our prevention efforts.”
But there is hope.
More health care providers are screening for the infection, researchers found. And relatively new drugs hit the market a couple of years ago that can cure most cases of the disease. The catch? They’re expensive, and not everyone has access. Some insurers – like Rhode Island’s Medicaid program for low income residents – require people to reach a certain level of liver damage from hepatitis C before the program will pay for the treatment. Medicaid officials say funds are limited. Chan says the drugs are still expensive, but they’re worth it.
“One of the biggest medical breakthroughs in the last decade has been these newer medications for hep C," says Chan. "And it’s a very exciting time and we do expect a lot of people to be cured for hep c. The biggest challenge in this is access to the medications and cost. And that’s something we’re actively working to address across the state as well.”
Nunn and Chan say the next steps should be to help spread the word to doctors and health systems that everyone at risk should be screened for hepatitis C. And they say more insurers should cover that treatment to curb the spread of the disease.
Read the document: "Epidemiological Profile: The Hepatitis C Epidemic In Rhode Island" (prepared by the Rhode Island Public Health Institute)