Through its Per-SVR study (pronounced “persevere”) the BC-CfE is conducting important research to determine thresholds of prevention methods, such as harm reduction and safer sexual practices, to prevent hepatitis C reinfection among key populations. Per-SVR is a multi-year study observing people who have been successfully treated for hepatitis C virus (HCV) with direct acting antiretrovirals (DAAs).
The hepatitis C epidemic disproportionately affects people who tend to be marginalized and can face barriers to care, such as individuals who inject drugs. Baby boomers also have high rates of hepatitis C. BC-CfE research has found the prevalence in this generation could be linked to the increase in medical procedures and use of reusable syringes in boomers’ childhood years.
The launch of the Per-SVR study comes at a moment when there is an opportunity and a movement to see an end to hepatitis C. Each year, on July 28, the United Nations (UN) marks World Hepatitis Day to bring attention to the global burden of the hepatitis C epidemic. It is now a UN Sustainable Development Goal to save 10 million lives by 2030 through effective hepatitis C treatment. In March 2018, the BC Government made treatment accessible to any British Columbian living with chronic hepatitis C.
The development of DAAs, the latest generation of hepatitis C drugs, have established a new ground for the treatment of hepatitis C. These treatments can effectively cure with few side effects in as little as eight weeks (as opposed to six months or longer on previous interferon-based treatments).
While hepatitis C can remain silent or asymptomatic for many years, the long-term effects can be devastating to health, such as cirrhosis, liver damage and liver cancer. Some individuals who before were hesitant to go ahead with hepatitis C treatment might now be seeking it out after hearing about positive effects from peers or health care providers. This was the case with Per-SVR participant Sage. “I kept going to [a hepatitis C support] group on and off for many years, but I never felt ready to go on treatment mostly because of my emotional and mental challenges,” says Sage. “What I was hearing from watching the other women going through treatment, I wasn’t ready to take the plunge.”
She is now very glad she completed DAA therapy. “It’s lifted a huge weight off my shoulders health-wise because it’s always been in the back of my mind, [thinking that] my liver is compromised even though I am taking herbs and supplements,” says Sage. “I have a lot of other health issues to deal with already so I feel like that’s something now that I can put behind me.”
Sage wanted to participate in the Per-SVR study to share her own experience with others, as well as contribute to data being collected about how individuals are doing post-treatment.
Per-SVR participant Angeline Jack says that, since going on treatment, she is “feeling a lot of hope, feeling healthier, more energetic.” Community and family supports were part of her decision to pursue treatment and addiction therapy opened a path. Jack suffered from substance abuse issues since childhood, which she said were a barrier to initially obtaining hepatitis C medications.
Now, Jack says she feels “powerful.” “I realized my health is mandatory to my life now,” says Jack. “Treatment made me feel grateful. When we do treatment, we learn about our system. It increases your availability to your body.”
Per-SVR will help inform a Targeted Disease Elimination™ (TDE™) strategy for hepatitis C in order to curb spread of the disease through cost-effective health interventions. Principles of the made-in-BC Treatment as Prevention¨ strategy for HIV, including early access to testing and treatment, can be applied to curbing another modern-day epidemic. Sustained HIV treatment can lead to the maintenance of an undetectable viral load in individuals living with HIV, rendering them uninfectious. However, individuals who have been treated for hepatitis C can be re-infected if effective prevention methods are not in place – which is why more investigation and research is needed.
Per-SVR will evaluate the potential impact of successful HCV treatment in terms of health care costs and resource utilization. “Through targeted interventions, improving quality of life while reducing the spread of hepatitis C can be done in conjunction with boosting the sustainability of our health care system,” says Dr. Lianping Ti, BC-CfE Research Scientist and Per-SVR Lead Researcher.
“The Per-SVR study is critical to informing a TDE strategy for hepatitis C,” said Dr. Julio Montaner, Director of the BC-CfE and Principal Investigator on the study.
People are eligible to participate in the Per-SVR study if they have recently achieved an undetectable viral load following treatment for hepatitis C with DAAs, are 19 years of age or older, live in British Columbia and are fluent in English.