Viral hepatitis is the focus of today’s World Digestive Health Day with Kiwi gastroenterologists pleased with recent increased access to treatment but concerned inequities remain.

Associate Professor Michael Schultz, the president of the New Zealand Society of Gastroenterology, said the society was “very pleased” with recent “incremental improvement” to managing viral hepatitis B and C which, if left untreated, can lead to liver failure requiring transplantation. Both can also cause liver cancer and premature death.

Currently around a third of patients with Hepatitis C don’t have access to a funded therapy and the Society says Pharmac successfully concluding negotiations with the drug providers needs to be a ‘priority’ to address the significant inequity faced by these people.

But Schultz says access is about to opened to two medications that are the mainstay of Hepatitis B treatment ­– Tenofovir and Entecavir – due to Pharmac negotiating contracts for equivalent generic versions of the treatments.

“Currently less than 25% of hepatitis B patients receive the recommended therapy,” said Schultz in the Society’s World Digestive Day statement.  “Many patients with Hepatitis B live in economically disadvantaged or geographically isolated parts of the country. The incidence is high in Māori and Pacific people.” He said freer access to treatment, along with educational programmes, will enable more patients to be identified and managed in primary care in their local community.”

Hepatitis C had different challenges in New Zealand.  Since 2016 New Zealand has funded the direct acting antiviral agents (DAAs), that have transformed the management of hepatitis C, as a 12 week course can cure about the two-thirds of New Zealand hepatitis C cases who have genotype 1 hepatitis C.

“This advance has raised the possibility eradicating the disease from New Zealand – as is the plan in many other countries including Australia,” said Schultz.

But about a third of patients here have genotype 3 Hepatitis C. These patients cannot be cured by the currently funded therapy Viekira DAA therapy.

Schultz said the Society understood that Pharm was currently in negotiations to obtain the medication therapy that does work for genotype 3 and that could help address the inequity of access to treatment

He said there remained other pieces in the puzzle necessary to eradicate hepatitis C. There are an estimated 25,000 patients who remain undiagnosed and the Society believed strategies need to be found to contact this group of patients and provide treatment.

“This will require a multipronged approach with public education, destigmatisation, engagement of general practices, increased testing and the use of health targets and a registry,” said Schultz.

There is a Hepatitis C (HCV) summit meeting in July to work on a developing an eradication plan and the Society was encouraged that the Minister of Health would be involved. “With development of this plan national elimination of Hepatitis C is a possibility,” said Schultz.

Because the liver plays an important role in the digestive system, people who have hepatitis-related liver damage can also suffer upset stomachs, diarrhoea and abdominal cramps.

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