MAC calls for urgent action to manage growing burden of hepatitis C
Undiagnosed and untreated hepatitis C virus (HCV) infection may lead to an epidemic in the next decade, shows a new report by the Malaysian AIDS Council (MAC).
The report—launched in conjunction with World Hepatitis Day on 28 July—highlighted that there were 3,393 notified HCV infections in 2016 alone. The number of HCV cases in Malaysia is currently estimated between 435,000 and 500,000, which is about 2.5 percent of the general population while HCV prevalence among people who inject drugs is even higher and estimated at 50 to 67 percent. [At the Edge of a Miracle: The Hepatitis C Epidemic in Malaysia. Available at: www.mac.org.my/v3/wp-content/uploads/2017/07/HCV_Report_A4_FA_23052017-web.pdf Accessed on 27 July]
A study in 2009 on 552 Malaysians who used drugs and not on treatment showed that about 65 percent were seropositive for HCV and out of those about 43 percent were coinfected with HIV. [Drug Alcohol Rev 2009;28:447–454]
“Given the overlapping modes of transmission, HIV-HCV coinfection—particularly among people who inject drugs—is a significant public health concern, in addition to missed opportunities for earlier diagnosis due to the asymptomatic nature of HCV infections,” said Hisham Hussein, MAC’s honorary secretary.
He noted that collaborative efforts among MAC, Ministry of Health (MOH), universities, Third World Network and other organizations are needed to address the HIV-HCV treatment cascade. Testing among high-risk populations as well as the cost effectiveness of testing and treatment need to be accelerated in response to the rate at which the epidemic is growing.
Although there is a cure for HCV infection, treatment is expensive with a range of RM35,000 for one year to US$12,000 for three months. Many people are unable to afford the treatment. MOH is looking into lowering the cost to improve patients’ accessibility to treatment, said Hisham.
HCV infection leads to clinical and economic burden, said Professor Rosmawati Mohamed, consultant hepatologist, University Malaya Medical Centre. “If we do nothing, there will be increasing annual incidence of cirrhosis, liver cancer and decompensated cirrhosis advancing to liver failure in patients.
“The disease burden is forecasted to rise steeply over the coming decade. As the disease advances, the cost to the healthcare system will also increase,” she said.
The new combination, direct-acting antivirals (DAAs) have shown better cure rate of up to 95 percent. They can be taken orally and are well tolerated. In general, everyone can be considered for this therapy provided they are willing to undergo treatment and do not have contraindications. Treatment duration is only 8 to 12 weeks, she said.
Hisham and Rosmawati were speaking at the launch of the report in Kuala Lumpur recently.