Curing the Most Deadly Communicable Disease on the Planet

Michelle Gamage/Local Journalism Initiative Reporter/The Tyee. Dr. Brian Conway, medical director of the Vancouver Infectious Diseases Centre, was recently named an ‘Elimination Champion’ for his work to eradicate hepatitis C.

Michelle Gamage, Local Journalism Initiative Reporter, The Tyee

The hepatitis C Virus kills more people than most other communicable diseases, including AIDS and tuberculosis, says Dr.  Brian Conway, medical director of the Vancouver Infectious Diseases  Centre. Conway was recently named an Elimination Champion for his work fighting the disease.

This excludes COVID-19 which, as a generational pandemic gets measured differently by infectious disease experts, Conway adds. 

HCV killed 290,000 people globally in 2019 according to the World Health Organization, including 1,162 Canadians. 

Conway says between 200,000 to 210,000 people are infected in Canada and the provincial government estimates 16,000 British Columbians have chronic HCV infection. 

The provincial government has signed on to the World Health Organization’s goal of eliminating HCV by 2030.

As of 2017, globally only  20 per cent of infected patients have been diagnosed and two per cent of  all those infected are being treated, according to the CDA Foundation.

In Canada it’s closer to 30 per cent who  don’t know they’re infected because they haven’t been tested, don’t  think they’re at risk or don’t feel sick, Conway says. 

Treatment for HCV is free under BC PharmaCare for people with Personal Health Numbers. 

People  who use drugs, people who have spent time in prison, Indigenous  Peoples, men who have sex with men, immigrants from certain parts of the  world and Baby Boomers are all populations at higher risk of HCV  infections, according to Conway. 

Over time, Conway adds, an HCV infection  will cause liver failure. Patients can develop a swollen stomach, have  difficulty thinking, bleed from their stomach and esophagus, develop  rashes, be overly tired — which are symptoms of liver failure — or  develop liver cancer. 

“It can take decades to develop but you can  look and feel perfectly well until your liver fails and you can be  transmitting hepatitis C in the meantime,” Conway says. 

HCV is a blood-borne disease so it can be  transferred during intravenous drug use, sex or childbirth, Conway says.  In other parts of the world people are infected when they receive  unscreened blood transfusions or unsafe health care, according to the  WHO. 

Conway says Baby Boomers are at higher risk  of HCV infections because many of them experimented with drugs or sex  when they were younger and may not remember the incident that infected  them, meaning they never get tested or seek treatment. 

To treat HCV a patient has a choice of taking one of two direct-acting antiviral agents in pill form. Epclusa is taken once a day for 12 weeks and Maviret is three pills taken once a day for eight weeks. Both of these treatments  have minor side effects and cure people 98 per cent of the time, Conway  says. If those pills don’t work patients will be prescribed a second  medication, Vosevi, which is 95 per cent effective. 

“Put this all together and almost everyone gets cured eventually,” Conway says. 

These medications have been fully covered by the BC PharmaCare program since 2018, according to the provincial government. 

So why are infection rates still so high in B.C.? 

That’s generally because  people either don’t know they’re infected or hepatitis C is “nowhere  near their top priority,” Conway says. 

He’s been working in Vancouver’s Downtown  Eastside neighbourhood since 1998 and says engaging people in care is a  huge part of getting people to start treatment. 

“If there’s a guy whose been sleeping on  the street, is using drugs and is thinking about eating a several  day-old sandwich and I walk up to him and say, ‘you know what your  problem is? You’ve got hepatitis C,’ I’m going to have zero credibility  and he’s going to ignore me,” Conway says. “That doesn’t get him into  treatment or cured.” 

So Conway developed systems of outreach at  community centres and, more recently, in housing projects to connect  with people where they live. 

“We meet with them to engage them in care  and to provide them with HCV treatment within a multidisciplinary  programme that helps meet all of their needs,” he says. The team also  helps connect patients with housing, social programs, health care and  addictions treatment.

For the past six years Conway says these  systems of outreach have been getting 15 to 20 people into treatment per  month. Ninety-eight per cent of people who start treatment go on to  complete it, he adds. 

Adding to this outreach Conway opened the Urban Health Centre  at 219 Main Street this spring in partnership with Vancouver Infectious  Disease Centre, the pharmacy SRx-Pier Health and Atira Housing. 

Patients are welcome to walk in and an  outreach team works in the neighbourhood to help find and connect with  people who may need HCV treatment. 

Since opening three months ago the clinic has enrolled 250 patients and started 16 people on HCV treatment. 

Partnering with housing entities and the  Public Health Agency of Canada means building managers and nurses giving  people COVID-19 vaccinations can also flag patients who may have  hepatitis C and need treatment, Conway adds. 

He estimates over the last six years he’s cured between 2,500 to 3,000 patients of hepatitis C. 

Treatment wasn’t always this easy. When  Conway started work the existing HCV treatment took six to 12 months.  Side effects included anemia, and making people feel like they were sick  with the flu. The treatment worked 50 per cent of the time, Conway  says. 

The invention of direct-acting antiviral  agents in 2015 revolutionized treatment and was “one of the most  remarkable things that has happened in my career,” he says. “Treatment  became dead easy.” 

More work is being done to eliminate the virus from B.C. 

On Monday the provincial government  announced a partnership between the BC Centre for Disease Control, the  BC Centre for Excellence in HIV/AIDS and the BC Hepatitis Network to  create a made-in B.C. HCV-treatment and a hepatitis-elimination roadmap.

The province dedicated $105,000 towards  creating the roadmap, which will define short-term targets for  screening, treatment, engagement in care and community-based prevention  and education, which the province says will be fully aligned with B.C.’s  goal of eliminating HCV by 2030. 

In 2018 the province tested 270,000 people for HCV. 

Conway says he’d like to see every adult  tested for hepatitis C once in their lifetime, like the U.S. is  implementing. Germany also has a mandatory health check for every  35-year-old, where people are tested for hepatitis, diabetes and other  health concerns. 

“At minimum we should screen all populations who are at high risk,” he says.