[e-drug] Treatment of Hepatitis C Virus Infection

["Chris W. Green" <chrisg@rad.net.id>]

E-DRUG: Treatment of Hepatitis C Virus Infection
---------------------------------------------
[Is this another sort of 'disease-mongering'? 
See E-drug archive Disease Mongering - April 14, 2006.
 http://www.essentialdrugs.org/edrug/archive/200604/msg00038.php  BS ]

It seems to me that the current treatments for HCV are now being pushed 
as hard as possible to 'make hay while the sun shines', before new, 
cheaper and more tolerable treatments become available.

Are others seeing a similar push on HCV testing and treatment?

I am becoming increasingly concerned over what appears to be somewhat 
questionable 'marketing' of hepatitis C virus (HCV) infection in 
Indonesia. People are being encouraged to test for HCV in order to be sure 
that they are 'free' of the the virus, so that they do not 'become a time 
bomb for their community and those they love' (translation of a Roche 
Indonesia release).

What I see happening again and again is that people are being encouraged 
to take an antibody test for HCV, without being aware that if the result 
is positive, this may not indicate chronic infection, and that they will 
have to have a viral load test to confirm this. The cost of such a test is 
prohibitive for most, as well as being very difficult to access.

The release also notes that HCV infection may be cured. It fails to note 
the challenges involved in the possible cure, or that there is still some 
controversy over whether HCV infection can indeed be cured. People, mostly 
co-infected with HIV, are being encouraged to start this treatment, 
without being aware that they really need an (expensive) genotype test 
first, without being aware of the low cure rate, and without being aware 
of the excruciating side effects that often continue almost unabated for 
the period of treatment (usually 12 months). They are also unaware that of 
the huge cost. They are often not informed that one element of the therapy 
is teratogenic, even if only taken by the male partner.

Co-infected folk are also being encouraged to start HCV treatment even 
with CD4 counts in their teens!

It is my understanding that HCV treatment is rarely an emergency, and that 
the current treatment situation is similar to that for HIV in the mid-
1990's, with a number of new and much more tolerable drugs in the 
pipeline. It seems to me that the current treatments are now being pushed 
as hard as possible to 'make hay while the sun shines', before new, 
cheaper and more tolerable treatments become available.

I am indeed very concerned over the rates of HIV/HCV co-infection in what 
is here a largely injecting drug use-driven HIV epidemic. But while those 
co-infected are fairly comfortable about their HIV infection (with better 
access to information and treatment), they view their HCV infection as a 
'black hole', with poor access to information, and a lack of health care 
providers who fully understand both infections and their interactions. 
This leaves them very vulnerable to pressure such as this.

It is my view that many HIV-infected drug users may be better off not 
being tested for HCV, since they cannot possibly afford the viral load 
test, let alone the genotype test or the treatment. This should be 
explained to them, but they should probably not be encouraged to have the 
test, which (for IDUs) will almost certainly be positive, but which only 
leaves them more confused.

Amazingly, it is much less common here for those with HIV infection to be 
tested for hepatitis B virus (HBV) infection. This is an infection which 
can be prevented, can be treated more easily, but which can be adversely 
affected by thoughtless antiretroviral therapy.

Chris
-- 
Chris W. Green (wartaaids@gmail.com)
AIDS Treatment Educator, Spiritia Foundation
Jakarta, Indonesia
Tel: +62 (21) 422-5163  Fax: +62 (21) 4287 1866
Web site: <http://spiritia.or.id>
"Chris W. Green" <chrisg@rad.net.id>