Strict criteria for treatment eligibility in British Columbia and Ontario are driving some patients infected with hepatitis C virus to inflame their livers deliberately, experts say. Drug plans in these provinces will only provide antiviral treatment if patients submit documentation of significant liver damage. In contrast, Alberta provides treatment for HCV if a doctor prescribes it.
"The binge drinking is huge," said Fran Falconer, an HCV support nurse on Vancouver Island. "For the liver, drinking [alcohol] is like putting grease on a flame. It's like fertilizer to the hepatitis C virus."
"I see patients that are willing to do anything to get rid of the virus," Falconer said. "Patients shouldn't have to stoop to those levels in order to access care and treatment."
About 50,000 people in British Columbia have HCV, more than in any other province, according to the B.C. Center for Disease Control.
Dr. Brian Conway, an infectious-disease specialist who runs an HCV clinic in downtown Vancouver, said patients are asking on a daily basis how best to inflame their liver in order to raise their enzyme levels to qualify for treatment. Conway advises patients against harming the liver.
Of Conway's patients, 200 are on antivirals, including some through clinical trials funded by pharmaceutical companies. Another 250 are waiting for treatment, and probably 50-75 will be rejected by the provincial drug plan, he estimated.
"The rules need to change so we don't have to argue for coverage, case by case," Conway said.
The approval process is unique to HCV, said Dr. Morris Sherman, head of the Canadian Liver Foundation's board. "There is no restriction on HIV drugs, or TB drugs, but for hepatitis B and C, the approach is different," he said.
Kevin Falcon, the B.C. health minister, said the significant side effects associated with HCV treatment are the reason the decision to treat is left to an approval committee, not to an individual patient's physician.