Most people with hepatitis C go untreated, despite effective drugs

Just 20 percent of people infected with the hepatitis C virus (HCV) begin the recommended treatment regimen and less than 5 percent go on to successfully overcome the virus, according to a new review in General Hospital Psychiatry. This is despite the availability of highly effective anti-viral drugs that clear hepatitis C virus in about 80 percent of patients participating in clinical trials. Major barriers to recommended care are substance abuse and depression in HCV patients.

Other barriers to treatment include patients' attitudes toward treatment, including a fear of the side effects associated with some of the anti-viral drugs and an inability or unwillingness to abstain from drugs or alcohol, which is required for successful treatment.

As many as 4 million Americans have chronic hepatitis C, which is a blood-borne viral infection that is the most common cause of severe liver disease and liver transplants in the United States. In the past, hepatitis C was sometimes transmitted during medical procedures such as blood transfusions but this risk has been significantly reduced. The illicit use of injection drugs is the primary source of new infections.

People who engage in high-risk behavior in their youth often don't realize they have HCV until they reach middle age and are diagnosed with end-stage liver disease, said Barry Hong, Ph.D., of Washington University School of Medicine in St. Louis, a coauthor of the review. Recently, the Centers for Disease Control and Prevention recommended that all baby boomers be screened for HCV.

"Screening patients with psychiatric and substance use disorders is also a must," notes Muhamad Aly Rifai, M.D., a psychiatrist specializing in mental illness and hepatitis C at the Commonwealth Medical College in Pennsylvania.

The findings suggest that many of these barriers to care can be readily addressed through education or by treating patients' mental conditions before or during treatment for HCV, including the use of anti-depressants, the authors suggest.

In addition to their high risk health behaviors, many HCV patients also face practical barriers to accessing treatment such as lack of transportation, good social supports, or adequate housing. The authors recommend providing a multidisciplinary treatment approach that involves social workers, physician assistants and others to provide assistance.

The review also "underscores the need for better anti-HCV regimens with fewer side effects," notes Frederick Askari, M.D., Ph.D., a hepatologist at the University of Michigan Medical Center. "Fortunately better treatments are on the horizon, with over 20 promising compounds in various stages of clinical development."