When doctors and insurance companies make the call to postpone treatment, the delay comes with risks.
Hepatitis C is a potentially curable infection that affects an estimated 3 million people in the United States, buttreatment is sometimes delayed, for a variety of reasons. If you have a chronic hepatitis C infection, delaying treatment can pose significant health risks.
Hepatitis C causes inflammation in the liver. Without treatment, the inflammation can create permanent scar tissue called cirrhosis, which can ultimately lead to liver failure, says Hyder Z. Jamal, MD, a gastroenterologist at St. Jude Medical Center in Fullerton, California. From 5 percent to 20 percent of people with hepatitis C develop cirrhosis of the liver, according to the Centers for Disease Control and Prevention (CDC).
“Hepatitis C is the No. 1 cause of liver transplants in the U.S.” Dr. Jamal says. “It’s important to treat hepatitis C before the liver is severely damaged, because liver failure can be deadly.” Between 1995 and 2010, about 41 percent of the 127,000 newly registered candidates for liver transplant had hepatitis C, according to data from at the Organ Procurement and Transplant Network published in Liver Transplantation.
People with hepatitis C are also at increased risk of developing liver cancer, according to the American Liver Foundation. And a study published in Hepatology points to cirrhosis as a predominant risk factor for liver cancer. TheWorld Health Organization reports that 1 percent to 5 percent of people with chronic hepatitis C will develop hepatocellular carcinoma, the most common type of liver cancer.
6 Reasons for Delayed Hepatitis C Treatment
Even though these health risks are well known among healthcare providers, treatment for hepatitis C does not always come quickly. The reasons vary widely. Here’s a look at some of the more common causes for delay, and the dangers these pose to your long-term health and close relationships.
1. No diagnosis. You can have hepatitis C and not know it. Symptoms may seem like the flu and pass just as quickly as they appeared, or you may not have any symptoms at all, Jamal says. The danger here is that damage to your liver can develop even when you don’t have symptoms, which is why getting tested is so important. And you risk passing on the hepatitis C virus to others without realizing it.
The CDC recommends that all baby boomers get tested for hepatitis C at least once. Other situations put you at increased risk of having hepatitis C. If you fit in these categories, you should get a hepatitis C blood test:
- You were born between 1945 and 1965.
- You received donated blood or an organ transplant before 1992, when the blood supply began to be screened for the disease.
- You were ever exposed to blood from a person with hepatitis C.
- You have ever engaged in risky behaviors like injecting drugs.
- You had a tattoo in an unregulated setting, like from a friend.
2. Medication interactions. Some hepatitis C drugs interact with other medications and so treatment is put off, says Jacqueline G. O’Leary, MD, MPH, medical director of research at Baylor Simmons Transplant Institute at the Baylor University Medical Center in Dallas. When drugs interact, the way each individual drug is metabolized in your body can be altered, meaning too much or too little drug exposure, according to research published in Expert Opinion on Drug Metabolism & Toxicology in March 2015. The state of your liver is another point to consider because certain drugs – antiretroviral medications used to treat HIV, for instance – can cause drug-induced liver injury when taken with hepatitis C drugs. If you have advanced liver disease, your medication dosages may need to be modified to prevent toxicity.
If you’re taking a medication that can have a severe interaction with hepatitis C therapy, your doctor may be able to switch you to a different medication, Dr. O’Leary says. If not, the key is prioritizing which condition to treat first. It’s important to work closely with your doctors so that you understand your options and all potential risks involved.
3. Alcohol or substance abuse. If there’s concern that your liver will continue to be exposed to substances like alcohol or drugs, or if you have a history of substance abuse, your doctor or insurance provider may postpone treatment. The concern is that continued use of alcohol or other substances can further damage your liver.
Alcohol reduces responsiveness to anti-viral therapies for hepatitis C, according to a report published in Biomolecules in March 2015. The drugs work by restoring innate immunity. By continuing to drink, people with hepatitis C could have their immune response suppressed by both the virus and their alcohol use, potentially diminishing the function of the hepatitis C drug.
Some insurance providers require six months of abstinence from alcohol and substance abuse before giving the go-ahead for treatment. Talk with your healthcare provider if you need help to stop drinking or taking drugs, Jamal suggests, as there are programs and medications that can help.
4. Absence of liver disease. If blood tests confirm hepatitis C but a biopsy doesn’t show liver damage, your doctor may not begin treatment immediately. In this case, your condition could be monitored closely and doctors may recommend certain lifestyle changes to protect the health of your liver, according to the American Liver Association.
The risk is that some people may not follow up as directed for ongoing monitoring, says Hwan Y. Yoo, MD, PhD, a liver specialist at the Institute for Digestive Health and Liver Disease at Mercy Medical Center in Baltimore. Infecting others is also a concern because the virus can be spread even if you aren’t experiencing symptoms.
5. Mental health concerns. Doctors or insurers may hold off treating hepatitis C in people already being treated for certain mental health issues. That’s because some hepatitis C medications may worsen depression and other mental health problems, according to the American Liver Foundation. For instance, drugs used to treat psychiatric disorders could interact with a commonly prescribed combination of hepatitis C medications — certain antivirals with interferon-alpha and ribavirin — and lead to problems managing psychiatric side effects, according to a study published in the Journal of Hepatology.
Newer antiviral hepatitis C drugs may offer a solution. In a review of data from major clinical trials, researchers found “minimal” risk of adverse behavioral or psychological effects when hepatitis C is treated with antiviral drugs. In a report in BMC Gastroenterology in 2013, investigators noted that some mental health medications may pose a high risk for negative interaction. That makes it imperative that your healthcare provider knows about all medications you’re taking.
6. Money matters. This could be lack of insurance coverage or other financial concerns. The newest hepatitis C drugs are expensive, more than $1,000 per pill, totaling over $80,000 for a full treatment regimen, so insurance authorization may take time, Dr. Yoo says. “Even though many patients are able to get authorization from the insurance company, there are situations with denial of treatment or ending up with high co-pay,” he explains.
Delaying treatment because of cost gives the disease more time to progress and could ultimately result in a need for additional medical intervention and more expensive care, Yoo says, for example, a liver transplant. In 2014 the average amount billed for a liver transplant in the United States was $739,100, according to a report by Milliman.