The promise of eliminating viral hepatitis
By Andrew Reynolds @projectinform

Welcome to the 5th Annual POSITIVELY AWARE Hepatitis B and C Drug Guide. In last year’s Guest Editor’s Note, I wrote “we stand at the beginning of the end of hepatitis C” and “the only question is how fast we can end it?” Fast forward a year and we may have our answer: 2030.

Before looking ahead, it’s worth looking back to see how far we’ve already come. For the longest time, people with hepatitis C (HCV) only had interferon and ribavirin as their treatment option. This treatment was long, miserable, and not very effective. Beginning in 2011, we started to see new, more effective (but still long and difficult) treatments for HCV. Then, beginning in 2013 the floodgates opened and several new HCV drugs and drug combinations came onto the scene each year, potentially curing 90–100% of people living with HCV in 12 weeks with mild side effects. Indeed, this year we will see two more drug combinations made available, creating a scenario where we can treat and cure just about everyone.

Progress has been much slower on the hepatitis B side. Unlike HCV, we have not found a cure for it yet. There are medications that one can take to reduce liver damage and long-term risks. Also unlike HCV, we do have a vaccine to prevent HBV. And while there has been significant progress in vaccinating against HBV, there are still groups of people we are missing. We can, and must, do better.

This year the National Academies of Sciences, Engineering and Medicine released a report entitled “A National Strategy for the Elimination of Hepatitis B and C.” In it, they make a series of recommendations that, if followed, serve as a blueprint to prevent new infections, cure existing HCV infections and treat and manage hepatitis B until a cure is discovered.

The time to act on this is now! The United States is in the midst of an opioid crisis, leading to an increase in HCV and HBV infections among people who inject drugs. We have limited access to harm reduction services such as syringe access and medication-assisted therapy (methadone and buprenorphine), two interventions proven to reduce new infections. The cure for HCV is at hand, but the insurance restrictions and high cost of treatment serve as significant barriers for most people.

And yet, we appear to be moving backwards. The repeal of the Affordable Care Act will leave millions of people, including people with HCV and HBV, without health insurance and reduce access to drug treatment. Access to safer injecting equipment and other harm reduction interventions remains out of reach for most. Indeed, the current presidential administration has indicated that they will ramp up the failed war on drugs, a policy that has driven the HCV epidemic, led to significant suffering among people who use drugs, and decimated communities of African American and Latino men and women thrown into prisons, due to increased policing, minor drug offenses and racist sentencing laws.

We know what works, and we know what doesn’t. Restricting access to healthcare and drug treatment, limiting prevention measures, and trying to incarcerate our way out of our drug problem are not solutions to HBV and HCV prevention, care, and treatment.

POSITIVELY AWARE and Project Inform are committed to ending viral hepatitis. In addition to this expanded “Hepatitis B and C Drug Guide” and the inclusion of HBV, we will continue to publish new articles online and in print. We will report news and updates on innovative treatments and prevention, as well as policies that can improve the health of people living with viral hepatitis. That is our promise to you.

Once again, I thank Jeff Berry and Enid Vázquez for their kind and gentle editorial guidance. I tend to write a lot, and were it not for them there’s no telling how large this issue would be. Rick Guasco did another fabulous job designing the issue. With their support and effort, we’ve made this hepatitis drug guide more comprehensive, easier to read, and, I hope, more useful to people living with, or at risk for, HBV and HCV.

And finally: Let’s see if we can meet the goal of eliminating viral hepatitis before 2030. We have the tools to do it already. What we need is the will to put those tools into action. Patients are ready. Medical providers are ready. Advocacy and policy experts are ready.

Let’s do this!

Andrew Reynolds