Hepatitis C has a significant impact on immigrant populations 

THIS year, Kamal, 23, and her mother Harpreet, 48, are celebrating a special bond. Both diagnosed with chronic hepatitis C, they have been treated and are now cured of their disease. This is one family that has been part of an effort to screen, treat and eliminate hepatitis C among the Punjabi community in B.C. Although stigma still exists (the reason this mother and daughter are not using their real names), they are sharing their story to encourage others in the community to step forward, and to be screened and treated.

Chronic hepatitis C is a liver infection caused by the hepatitis C virus (HCV), and is one of the leading causes of death from infectious disease in Canada. Immigrant populations account for a disproportionate number of all HCV cases in Canada. The Public Health Agency of Canada estimates that immigrants have a two-fold higher prevalence rate of HCV than those born in Canada. As a result, HCV-infected immigrants are more likely to develop cirrhosis and liver cancer and experience liver-related death. They also experience a long delay to HCV diagnosis (10 years) and linkage to liver-related care (15 years) after arrival in Canada – more than other persons with HCV.

Kamal was 14 when she underwent a number of medical and blood tests as a result of kidney issues. That was when she “surprisingly” learned she had hepatitis C. Given she was too young for treatment, and her disease was in early stages, Kamal finally committed to treatment in late 2017, and was cured in March 2018. Kamal’s mother believes she, herself, contracted hepatitis C back home in India. In 2017, Harpreet had early signs of scarring to her liver. She started treatment and was cured three months before her daughter. Harpreet continued to work through treatment, and treatment did not impact her day-to-day life.

“We are in a new era with hepatitis C treatments providing very high cure rates. These treatments are now publicly funded for all persons with hepatitis C. We must act now to identify high-risk patients and populations, and link them immediately with health care services in order to reduce the risk of transmission, complications of liver cancer or liver failure, and ultimately, eliminate the disease,” said Dr. Alnoor Ramji, Clinical Associate Professor of Medicine, Gastroenterology, University of British Columbia.

Kamal says a future career in medicine and being in a “serious” relationship, impacted her decision to seek treatment and cure. Since her cure that she describes as a “psychological relief”, Kamal has completed a Bachelor of Science and Microbiology at the University of British Columbia, and is today advancing her education to become an optometrist or family physician. She also keeps active with swimming and boot camps.

“Cure provides you with the confidence to lead a strong quality of life. In our community, healthcare can be secondary behind family and work, but without good health how do you look after a family or perform a job,” Kamal says. “We must prioritize our health and take a more proactive approach to health care and talking to our doctors.”
The primary source countries of HCV in Canadian immigrant communities are India, Pakistan, China, India and the Philippines – all of which have large numbers of people living with hepatitis C. Many infections in immigrant communities can be traced back to their homelands, where unsterilized medical equipment and unsanitary medical facilities and practices are more common.

“Both my mother and I contracted HCV, unsure of where we could have been infected,” she says. “People need to know that having HCV is nothing to be ashamed of. Today, screening programs are more widely available and testing for HCV is a simple blood test. Once you know your status, treatment is as simple as one pill once a day for 12 weeks, and the chance for a cure is almost 100 per cent.”

Their story is far too common. As signs and symptoms of HCV are often silent, a person can carry the virus for decades without knowing. In many cases the virus is only detected when a patient experiences advanced liver disease, cirrhosis, liver cancer, or may require a liver transplant.

In British Columbia, it is estimated that 60,000 people live with chronic hepatitis C, and about 2,500 new cases of hepatitis C are identified in the province each year. In Canada, it is estimated that 250,000 Canadians are living with the chronic hepatitis C virus and 44 per cent are unaware of their infection. Canada is committed to the World Health Organization’s goal to eliminate HCV by 2030.

For more information on hepatitis C, contact the Hepatitis C Education and Prevention Society at www.hepcbc.ca