It is estimated that 150 million people are chronically infected with hepatitis C. The disease kills an estimated 700,000 people each year, the vast majority of whom live in developing countries where there is little or no access to diagnosis and treatment for the disease. While hepatitis C is found worldwide, Africa and Central and East Asia are the most affected regions.
Hepatitis C impact
Hepatitis C is a liver disease caused by the hepatitis C virus (HCV). The virus can cause both acute and chronic infection, ranging in severity from a mild illness lasting a few weeks to serious, lifelong illness. Infected people often do not show symptoms for many years. Hepatitis C is also a leading co-infection affecting people living with HIV/AIDS, who are more vulnerable to the disease because of their weaker immune systems and because HIV and hepatitis C share common modes of transmission. More than two million people with HIV worldwide are estimated to be co-infected with hepatitis C.
For more information: WHO hepatitis C fact sheet
- Transmission: A blood-borne virus, hepatitis C is most commonly transmitted through unsafe injection practices, reuse or inadequate sterilization of medical equipment, and the transfusion of unscreened blood and blood products.
- Signs and symptoms: While approximately 80 per cent of people do not exhibit symptoms after initial infection, those with acute infection may experience fever, fatigue, decreased appetite, nausea, vomiting, abdominal pain, dark urine, joint pain and jaundice.
- Diagnosis: As infection is usually asymptomatic, few people are diagnosed during the acute phase of the disease and remain undiagnosed until symptoms develop secondary to liver damage – often decades after infection. Serological tests are used to screen for anti-HCV antibodies.
- Treatment: Hepatitis C treatment is rapidly changing; new medicines called direct antiviral agents (DAA) are much safer and more effective than older treatments, and have fewer side effects.
- Prevention and control: Reducing risk of exposure to HCV is the best means of prevention as there is no vaccine for the virus.
New and much improved hepatitis C treatments have become available over the past few years that can cure hepatitis C in as little as 12 weeks. These safer, more effective therapies involve taking just one pill a day, a great improvement over other treatments that require painful injections and result in more serious side effects. MSF is in the process of starting to treat people who are living with HCV in at least nine countries, and therefore is in need of affordable access to these new treatments, known as direct antiviral agents (DAA), especially sofosbuvir and daclatasvir.
For access to treatment to be scaled up worldwide, the price of oral DAA drugs to treat hepatitis C urgently needs to come down. Competition among generic producers is already driving prices down, but many countries are not able to access these generic versions because of patent barriers.
US-based Gilead Sciences, who launched sofosbuvir in 2013, has priced the drug at US$1,000 per pill (US$84,000 for a 12-week treatment) in the US, and has charged similarly high prices across developed countries. Meanwhile, research estimates show the cost to produce a full 12-week course of treatment could be as low as US$101, or around US$1.20 per pill.
Gilead has entered licensing deals with several manufacturers in India who have developed and are starting to market generic versions of sofosbuvir, but the deals exclude a number of middle-income countries, leaving around 49 million people in such countries – representing more than 40 per cent of the global hepatitis C burden – without access to this drug.
MSF supports an effort launched by the Initiative for Medicines Access and Knowledge and the Delhi Network of Positive People to challenge Gilead’s patent application for sofosbuvir in India, so that more affordable versions of the drug can be freely produced and used in countries where they are needed.
Patents and restrictive licensing agreements should not stand in the way all developing countries’ efforts to provide people the treatment they need to stay alive.
Hepatitis C diagnosis and monitoring is complex, involving multiple steps and resulting in an expensive and resource-intensive process. Laboratory-based tests to measure hepatitis C viral load – needed to monitor the effectiveness of treatment – are complex, requiring well-resource laboratories and skilled staff. Simpler, affordable tests that are suitable for use in resource-limited settings are needed to enable access to hepatitis C treatment for all who need it.