Saskatoon

Hep C treatment is better than ever, but many Sask. patients aren't using it

Treatment for hepatitis C is easier, faster, and cheaper than it has ever been. But a specialized hep C nurse in Saskatchewan says a fraction of patients have been diagnosed and even fewer access the cure.

Province has the highest rate of hepatitis C infection. Treatment is free, efficient, and underused

Nurse clinician Lesley Gallagher and former hepatitis C patient Don Lesser examine a model of a liver at various stages of health. (Don Somers/ CBC)

It all started when one of Don Lesser's friends died of liver cancer.

"I thought I was next," said Lesser, who was diagnosed with hepatitis C shortly after the death. He started his first round of treatment a few months later.

It worked for a time, but after each gruelling round, the hepatitis C came back.

For the next three-and-a-half years, he lived an existence he describes as "hell." Symptoms of the gruelling pill regimen can include depression, weight loss, anemia and even anorexia.

Then a new treatment came along. The pill-a-day treatment cured him in eight weeks.

Treatment for hep C is easier, faster, and cheaper than it has ever been. But one specialized hepatitis C nurse in Saskatchewan says a fraction of patients have been diagnosed and even fewer access the cure.

Saskatchewan has the highest rate of hepatitis C of any province in Canada, even as the Global Viral Hepatitis Strategy sets a goal of eliminating hepatitis C and B by 2030.

Contraction difficult to pin down

Hepatitis C is a viral disease that affects a patient's liver. People with hep C present many and varied symptoms, from fatigue and body aches to loss of appetite and diarrhea.

Lesser figured aging was responsible for his discomfort.

The only reason he was diagnosed was that his general practitioner died. During his first appointment with a new doctor, she asked him if he had ever been tested for hepatitis C.

He had never even thought about it. The test came back positive.

Lesser was put on a cocktail of drugs. That treatment takes 24 to 48 weeks, with a 60 to 70 per cent chance of cure, according to a 2015 news release from the Saskatchewan government.

Lesser says it felt like chemotherapy.

He says he lost jobs because of the stigma surrounding the viral infection. It is commonly believed that hep C is inextricably linked to injection drug use, but there are other ways to contract the virus.

Everybody is eligible. Everybody has a right to these medications.- Nurse clinician Lesley Gallagher

It can be transmitted by shared needle use, unsterilized medical equipment and through sharing things like toothbrushes. Unsafe sex can also transmit the virus, but hugging and kissing cannot.

Lesser isn't sure how he was infected. He used intravenous drugs in the 1970s, but as far as he knows none of the friends he shared needles with were hep C positive.

Then he learned that Baby Boomers carry the highest rates of hep C.

From 1945 to 1975, inoculations and blood transfusions could have carried hepatitis C. Needles weren't always sterilized and blood wasn't screened the same way it is now.

Cure is free to patients, but underused

The newest treatment became accessible when the provincial government expanded its coverage in March 2017. Diagnosis includes a pin-prick and small blood sample to confirm hep C is in the blood.

Since 2015, the drugs Harvoni and Sovaldi have been covered. Two years later, patients gained access to Epclusa, Zepatier, Daklinza and Sunvepra.

Some patients take one pill a day, and others are on a more complex cocktail. The cure rate is similar across the board.

The duration of treatment depends on the strain of hep C, said Lesley Gallagher, hepatitis C nurse clinician at the Saskatchewan Infectious Disease Care Network.

Diagnosing hep C is easy. It starts with a small finger prick. If the 15-minute test comes back positive, the patient is sent for blood work. (Don Somers/ CBC)

"Everybody is eligible. Everybody has a right to these medications," she said. "There is no cost to the patient." 

The care network has set up offices across the province to educate people about hep C and to get them tested.

The situation is especially dire in the province's north, where access to health care is difficult and hep C testing is low.

In some communities, patients are likely to be reinfected after treatment because of intravenous drug use.

Don Lesser, cured of hep C, points at a chart showing healthy and unhealthy livers. (Don Somers/CBC)

Methamphetamine use is also often linked to hep C.

"There's got to be needle exchange programs," said Gallagher.

"The controversial but exciting supervised injection site that's coming to Saskatoon, this is something that sets the schedule. It's a little bit behind the times compared to other cities and other provinces."

45% diagnosed

Gallagher says education needs to reach potential patients, and it needs to start with doctors providing the test.

"Even with health-care providers there's still a lot of education that has to happen."

Some doctors refuse to give patients the test if they have few risk factors.

According to Gallagher, treatment numbers are expected to decrease from 2018 to 2019.

"I don't think that actually symbolizes that we're reaching patients and treating more. I think it means that we're just not diagnosing patients enough."

New hepatitis C treatment can be as easy as taking one pill a day, depending on the strain and person being treated. (Craig Chivers/CBC)

The virus's spread is growing and the care network can only work so fast to increase diagnosis and eliminate barriers to treatment. Gallagher notes that only 45 per cent of carriers are diagnosed and even fewer get to the pill regimen stage.

Lesser can't believe the lack of education around hepatitis C in the province. His goal is to end the stigma that keeps people from getting tested.

"I kicked its ass. I'm clear," said Lesser. "I feel 100 per cent better."

ABOUT THE AUTHOR

Bridget Yard is the producer of CBC's Up North. She previously worked for CBC in New Brunswick and Saskatchewan as a video journalist and later transitioned to feature storytelling and radio documentaries.