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Viral Hepatitis, B and C - Lift the Global Burden

World Digestive Health Day 29 May 2018

Viral Hepatitis, B and C - Lift the Global Burden

Viral hepatitis B and C are significant causes of suffering for New Zealanders. If left untreated both Hepatitis B and C can lead to liver failure requiring transplantation. Both can cause liver cancer and premature death. The Society are very pleased that there has been some incremental improvement to the management of these conditions in 2018.

Pharmac have been able to access equivalent generic versions of medications Tenofovir and Entecavir to treat Hepatitis B at a significantly reduced cost. Access will be opened. These two medications are the mainstay of Hepatitis B control. Currently less than 25% of hepatitis B patients receive the recommended therapy. Many patients with Hepatitis B live in economically disadvantaged or geographically isolated parts of the country. The incidence is high in Maori and Pacific people. Freer access along with associated educational programmes will enable more patients to be identified and managed in primary care in their local community.

Hepatitis C presents its own challenges in New Zealand. Direct acting antiviral agents (DAAs) have transformed the management of hepatitis C. A 12-week course of medications can cure most cases of Hepatitis C. This advance has raised the possibility eradicating the disease from New Zealand – as is the plan in many other countries including Australia. In 2016 DAAs became funded which are suitable for treatment of two thirds of the cases in New Zealand. This has enabled larger numbers of patients with genotype 1 Hepatitis C to be cured.

However, we are not yet in the position of being able to eradicate Hepatitis from New Zealand for a number of reasons. Approximately a third of patients here have genotype 3 Hepatitis C. These patients cannot be cured by the currently funded therapy Viekira DAA therapy. Therapy is possible for these patients but is currently unfunded in New Zealand. This represents a significant inequity.

Our understanding is that the process for obtaining these medications is still underway between Pharmac and industry. The New Zealand Society of Gastroenterology believes that the successful conclusion of these negotiations is a priority. There remain other pieces in the puzzle necessary to eradicate hepatitis C. There are an estimated 25,000 patients who remain undiagnosed.

Strategies need to be found to contact this group of patients and provide treatment. This will require a multipronged approach with public education, destigmatisation, engagement of General Practices, increased testing and the use of health targets / registry. There is an HCV summit meeting in July to work on a developing an eradication plan and NZSG is encouraged that the Minister of Health will be involved in this meeting. With development of this plan national elimination of Hepatitis C is a possibility.

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