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

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 oftreatment a few months later.

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

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

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. Thattreatment takes 24 to 48 weeks, with a 60 to 70 per cent chance of cure, according to a 2015 newsrelease from the Saskatchewan government.

Lesser says it felt like chemotherapy.

He says helost 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 rateis 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.

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

The care networkhas 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.

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 decreasefrom 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."

The virus's spread is growing and the care networkcan 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."