The World Health Organization released new guidelines around Hepatitis C (HCV) treatment this week, aiming to “promote the transition to newer, more effective medicines that have the potential to cure most persons living with hepatitis C infection.” The newer medications—called direct-acting antivirals (DAAs)—are more effective and easier to use than the old ones. And the new guidelines provide protocols on which specific regimens should be used based on a patient’s clinical history and the type of HCV.
Hepatitis C is the most common blood-borne virus in the United States, with 4-5 million Americans currently infected. Injecting drugs with contaminated equipment is the leading cause of HCV infection; the majority of people who inject drugs have been infected. The virus can cause serious liver disease, including cirrhosis and liver cancer, yet people who inject drugs often face discrimination when they try to get treatment.
The WHO updates, which in part aim to reduce discrimination against drug users, are mostly relevant outside of the US, which has its own set of treatment guidelines, according to Daniel Raymond, who serves as policy director of the Harm Reduction Coalition and is on the US guidelines committee.
The guidelines may be influential in reducing discrimination, he tells The Influence, in low-to-middle-income countries that don’t have their own rules. “When it comes to hep. C treatment and HIV treatment in most of the world, people who inject drugs are usually last in line for national treatment programs.” He adds: “There is language in the new guidelines about ‘human rights and discrimination’ faced by people who inject drugs. The guidelines continue to make a strong statement about treating people who inject drugs.”
The bad news is that the US continues to struggle to provide equitable access to treatment, Raymond says—even though the US guidelines say treatment should be considered for all people, regardless of their use of injecting drugs or stage of illness.
One reason for this treatment gap is the high prices that pharmaceutical companies charge for lifesaving drugs. “Even though there’s been a lot of scrutiny—not just of hep. C drug prices but of a lot of other drug prices that continue to increase—we don’t have a way for the federal government to negotiate drug prices,” Raymond says. “The frustrating thing is that high price of treatment in the US has led Medicaid and private health to essentially ration treatment to the sickest patients.” This means withholding drugs from people until the virus has already caused a certain amount of liver damage.
Another problem is that some states and insurance companies restrict treatment access to people based on their use of drugs and alcohol. But drug-testing patients to see if they qualify for treatment based on abstinence from substance use, says Raymond, is “simply discriminatory. There’s no medical reason. It’s based on stigma and discrimination.”
We’re starting to see legal action against restrictive state Medicaid insurance policies, he adds. For example, CMS (Centers for Medicare and Medicaid services) put out a statement a few months ago saying that some state restrictions are probably discriminatory.
This is a good sign. But in the meantime, many sick patients are still being denied access to care. And in many cases, the new WHO guidelines will not ease their difficulties.