The rising rate of hepatitis C in South Carolina has spurred state agencies to increase their efforts to screen for the virus that can cause liver disease if left untreated.
Though hepatitis C is now curable, the cost of the potentially life-saving drugs is prohibitive for poor, uninsured patients and the virus brings with it myriad complications, especially for those with HIV, experts say.
In South Carolina, the number of new hepatitis C diagnoses increased by 48 percent between 2010 and 2015, after five years of steady decline, according to information from the Department of Health and Environmental Control.
Lowcountry AIDS Services began screening for hepatitis C in some Walgreens in the tri-county area in April after seeing an uptick in cases. The South Carolina HIV/AIDS Council secured funding for 4,000 free statewide tests and is working with four other Southern cities to improve awareness.
Despite the increase in cases, the infection is now curable with drugs approved in recent years by the Food and Drug Administration. The challenge remains in finding patients who have hepatitis C, because many of them live with it for years and do not know.
"We could eradicate hepatitis C," said Vivian Clark-Armstead, program coordinator for the HIV/AIDS Council.
Experts attribute the recent increase to the growing problem of IV drug use and unsafe sex practices. It is also recommended that Baby Boomers be screened for the virus. Many were infected through blood transfusions before best practices were understood.
The HIV/AIDS Council began testing for hepatitis C about a year ago through Gilead Science's FOCUS Program. Of those the group found with a new hepatitis C infection in 2016, 56 percent were black and 75 percent were male. Two-thirds earned less than $5,000 per year.
The high cost of treating hepatitis C may turn many people away from treatment, said Nikki Harp, a project coordinator with the Council. The once-a-day pills that hepatitis C patients need to take cost up to $1,000 each and a full 12-week course of treatment runs as much as $80,000.
Gilead Sciences, the company that manufactures two of these costly hepatitis C drugs, offers drug assistance programs. Still, Harp said, many patients "feel they’re not going to be able to pay for it."
Before these new drugs were introduced to the market about three years ago, doctors treated people with both HIV and hepatitis C as a special group because HIV patients reacted poorly to prior hepatitis C treatments. Both viruses are blood-borne and can be spread through injected drug use or sexual contact. Among the 689 new cases of HIV found in South Carolina in 2015, 18 percent of those patients also had hepatitis C, according to DHEC.
Today, the outlook is better. HIV patients respond well to the new hepatitis C drugs, yet challenges for this "co-infected" population persist. Katherine Minnick, medical director of the Ryan White Wellness Center at Roper St. Francis, said injected drug use is the main culprit behind the new hepatitis C cases she sees among her young patients. The wellness center exclusively cares for patients with HIV and AIDS. The CDC reports 75 percent of HIV-infected people who also use injection drugs are infected with hepatitis C, too.
Minnick said injected drug use brings with it a "trashcan" of complications for her patients.
Eric Meissner, a researcher in the Medical University of South Carolina's Division of Infectious Disease, said in a minority of cases, health care payers may deny the hepatitis C drug to patients based on whether or not a patient abuses drugs or alcohol. They also consider the severity of their liver disease if the hepatitis C has progressed.
But Minnick said the much greater challenge lies in enrolling and in keeping people in treatment. Men who have sex with men and have become infected with these viruses are especially hard to reach, she said.
"There is no one I cannot treat," Minnick said. "But I cannot treat that population because they won’t come in."
Stigmas are the biggest barrier to caring for those with HIV, hepatitis C or both, she said, and those stigmas extend beyond men who have sex with men. Women and conservative Christians who are diagnosed with either virus can also be ostracized from their communities, Minnick said.
Meissner stressed HIV and hepatitis C are both preventable and that hepatitis C is curable. Focus should be placed on helping people become aware of their infections and getting them prescriptions, he said.
"There’s plenty of opportunity for us in South Carolina to impact the HIV and hepatitis C epidemics through education, collaboration and public health," Meissner said.
Editor's note: An earlier version of this story included a mistake about who may qualify for hepatitis C treatment. Meissner said it is less likely coverage will be afforded to a patient if they do not have severe liver disease. The story has been updated.