Good afternoon Chairperson Johnson and members of the Health Committee, I am Dr. Joseph Masci, Director of Medicine at Elmhurst Hospital Center, which is part of the New York City Health and Hospitals Corporation (HHC). I am also a Professor of Medicine – and also Preventive Medicine – at the Mount Sinai School of Medicine. On behalf of HHC, thank you for the opportunity to testify on efforts to increase screening, treatment and education for Hepatitis C and Hepatitis B. As you know, Hepatitis is a disease that inhibits the proper functioning of the liver and is a leading cause of death due to liver disease. The three most common forms of Hepatitis – are Hepatitis A and Hepatitis B and Hepatitis C. Hepatitis C (HCV) is the leading cause of liver cancer in the nation with mortality rates that have now surpassed that from AIDS.
In the U.S., 3.9 million Americans are estimated to be infected with Hepatitis C and 65-75% are unaware of their infection. Unfortunately, many of these individuals are not receiving care. Hepatitis B (HBV) is 100 times more infectious than HIV and has become the most common serious liver infection in the world. Approximately 1.25 million persons are chronically infected with HBV in the US. More than 150,000 Americans are expected to die from viral hepatitis associated liver cancer or end stage liver disease in the next decade.
Hepatitis C is most efficiently transmitted through contact with blood through injection drug use. Hepatitis B can be transmitted by blood and other body fluids, through direct blood-to-blood contact, sexual contact, injection drug use, and from an infected mother to a fetus/infant. Both Hepatitis C and B disproportionately affect minorities. HCV infection is complicated by the presence of sexually transmitted infections and also disproportionately affects persons who engage in high risk unprotected sexual activity, persons living in poverty and those men who have sex with men (MSM). There is evidence too that it may disproportionately affect transgender persons. All of these groups also have less access to care. In particular, African Americans and Hispanics are affected more by Hepatitis C and Asian and African immigrants are affected more by Hepatitis B. These disparities are of particular concern to HHC given our focus on reducing disparities and eliminating barriers to care.
The Centers for Disease Control and Prevention (CDC) estimates that although Americans born between 1945 and 1965 comprise an estimated 27 percent of the population, they account for approximately 75 percent of all Hepatitis C infections in the United States, 73 percent of HCV-associated mortality, and are at the greatest risk for developing hepatocellular carcinoma and other HCV-related liver diseases. While the recommendation to offer once in a lifetime screening and follow-up to this population is of most concern to address, there is recognition that some adolescents may also be at significant risk of HCV especially those who are starting to inject drugs.
An estimated 146,500 New Yorkers are infected with HCV but less than half may be aware of their infection. People who were born between 1945 and 1965 have a higher prevalence of HCV infection. In the past, treatment for HCV infection was long, fraught with severe side effects and not very effective. In addition, individuals who tested with traditional laboratory tests often never receive or return for their results, leaving many HCV infected persons unaware that they are infected. Recent advances in rapid HCV diagnostics and HCV medications have changed the landscape of HCV treatment because current treatments have significantly higher cure rates, at 95-100% in trials, have a much shorter treatment period and have many fewer side effects.
Rapid HCV screening technology and better treatment options provide a tremendous opportunity for improving health, saving lives, and reducing health disparities. With this easy testing and better-tolerated treatment, it is anticipated that more patients will complete treatment or avoid the most pernicious aspects of HCV infection. There is also a safe and effective vaccine to protect against hepatitis B infection. It is recommended that all infants, children and adolescents up to the age of 18 receive the vaccine as well as adults who are at risk for infection.
HHC is prepared to take advantage of the recent advancements in treatment and diagnostics to build on or modify our service structure and apply what we have learned addressing the HIV epidemic to reduce the burden of Hepatitis in New York City. With additional resources, HHC could collaborate with DOHMH, community-based organizations, other stakeholders as well as pharmaceutical and diagnostic testing companies to create an infection response program that would:
HHC is committed to improving patient outcomes by delivering comprehensive high quality medical care and supportive services to patients with Hepatitis C or Hepatitis B. With a commitment over time, new innovations in testing and treatment interventions, we are hopeful that we can make great strides in reducing the transmission and burden of these diseases in New York City.
This concludes my testimony. I would now be happy to answer any questions you have.