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From Retirement To The Front Lines Of Hepatitis C Treatment

Jan 3, 2018
Originally published on January 2, 2018 11:17 pm

When a hepatitis C treatment called Harvoni was released in 2014, Dr. Ronald Cirillo knew it was big.

"It's the reason that dragged me out of retirement!" he says.

Cirillo specialized in treating hepatitis C for more than 30 years in Stamford, Conn., before retiring to Bradenton, Fla. During his time in Connecticut, the only available treatment for hepatitis C had terrible side effects and it didn't work very well. It cured the viral infection less than half the time. But the newer drugs Harvoni and Solvaldi cure almost everybody, with few adverse reactions.

"In my lifetime I've seen it change from a horrible treatment to a manageable treatment," Cirillo says.

His mission is finding the patients.

"The disease is out there," he says. "My job is to get the disease in here so we can follow them and treat them."

Cirillo joined the Turning Points free clinic last year. It's in Bradenton, about an hour south of Tampa. The clinic primarily serves uninsured Floridians who fall into what many refer to as a coverage gap in states like Florida that chose not to expand Medicaid. Falling into this gap are people who make too much money to qualify for Medicaid in the non-expansion state, but can't get subsidies to buy insurance on the Affordable Care Act exchanges; subsidies kick in when people make 100 percent of the poverty level — about $12,000.

Cirillo is trying to test every high-risk patient he encounters. Today, his assistant pricks a patient's finger, and squeezes blood onto the end of a small plastic tube.

"And this little measuring tool goes into the blood and solution mix there," Cirillo says. "We are going to time it — 20 minutes and that's it. That's the test."

Nearly 30,000 people in Florida were found to have hepatitis C in 2016. It's likely that many more are infected, because the virus can lie dormant for decades.

Cirillo spearheaded a partnership with Harvoni's maker, Gilead Sciences, and that partnership has provided treatment to about 100 patients.

"We treat people without any insurance, that have no hope," Cirillo says."If you qualify to be a patient here, you'll get tested."

A 57-year-old patient named Patricia discovered she had hepatitis C a few months ago during a trip to the clinic. NPR is not using her last name because the virus is sometimes associated with illegal IV drug use. It can also spread via sex. Patricia says she's not sure how she got it.

"So, just because of my age, I guess, they went ahead and tested me for it and it blew my mind that I actually had hep C," she says. "And the levels ended up being really high."

The virus had started to scar and inflame her liver. But she lacked insurance and a job; the $94,000 Harvoni treatment would have been out of reach if she hadn't had financial help.

"I would never been able to afford that treatment," she says. "Never."

Staff at the clinic help patients fill out the complicated application from Gilead. Only patients who don't have insurance, have been drug-free for at least six months, and who meet income requirements are eligible.

Patricia was able to get the treatment — one pill a day for 12 weeks — and will be tested again in three months to determine whether she is free from hepatitis C.

"Had they not discovered it, really, and gotten me onto the program — who knows?" she says.

The Bradenton clinic is just one of many free clinics across Florida. But it stands out in its success in treating people who have hepatitis C.

This story was produced with the USC Center For Health Journalism's National Fellowship and Kaiser Health News.

Copyright 2018 WUSF Public Media - WUSF 89.7. To see more, visit WUSF Public Media - WUSF 89.7.

ROBERT SIEGEL, HOST:

We're going to hear now about a doctor at a free clinic in Florida. His mission is to cure as many people as possible who have hepatitis C. The treatment exists, but the medication costs more than $90,000. So he went directly to the drug company with a proposal. Julio Ochoa of WUSF in Tampa has the story.

JULIO OCHOA, BYLINE: When a hepatitis C treatment called Harvoni was released in 2014, Dr. Ronald Cirillo knew it was big.

RONALD CIRILLO: It's the reason that dragged me out of retirement.

OCHOA: Cirillo specialized in treating hepatitis C for more than 30 years. During that time, the available treatment for the virus had terrible side effects, and it didn't work very well. It only cured hep C less than half the time. But new drugs called Harvoni and Sovaldi cure almost everybody with few adverse reactions.

CIRILLO: This is easy, guys. What do you need here? Let's treat them. Let's get rid of this disease and move on to the next hepatitis that's going to come up. But in my lifetime, I've seen it change from a horrible treatment to a manageable treatment.

OCHOA: Cirillo joined the Turning Points free clinic last year. It's in Bradenton about an hour south of Tampa. The clinic primarily serves uninsured Floridians who make too much to qualify for Medicaid but can't get help buying Obamacare insurance. Cirillo is trying to test every high-risk patient he encounters. Today, his assistant pricks a patient's finger and squeezes blood onto the end of a small plastic tube.

UNIDENTIFIED MAN: And this little measuring tool goes into the blood...

UNIDENTIFIED WOMAN: OK.

UNIDENTIFIED MAN: ...And solution mix there. We're going to time it 20 minutes, and that's it. That's the test. Do we have a little Band-Aid for her?

OCHOA: Nearly 30,000 people in Florida were found to have hepatitis C in 2016, and many more likely have it because the virus can lie dormant for decades. Cirillo spearheaded a partnership with Harvoni's maker, Gilead Sciences, that has provided the treatment to about a hundred patients.

CIRILLO: We treat people without any insurance that have no hope. If you qualify to be a patient here, you'll get tested.

OCHOA: A 57-year-old patient named Patricia discovered she had hep C a few months ago during a trip to the clinic. NPR is not using her last name because the virus is associated with illegal IV drug use. It can also spread via sex, but Patricia is not sure how she got it.

PATRICIA: Because of my age I guess, they went ahead and tested me for it and blew my mind that I actually had hep C. And the levels ended up being relatively high.

OCHOA: The virus had started to scar and inflame her liver. But without insurance or a job, the $94,000 Harvoni treatment was out of reach.

PATRICIA: I would never have been able to afford that treatment - never.

OCHOA: Staff at the clinic helped patients fill out the complicated application from drug maker Gilead. Patients must have no insurance, be drug-free for at least six months and meet income requirements. Patricia received the treatment - one large pill a day for 12 weeks - and will be tested again in three months to determine whether she is free from hepatitis C.

PATRICIA: Had they not discovered it really and gotten me onto the program, who knows, you know?

OCHOA: The Bradenton clinic is just one of many free clinics across Florida, but it's likely the only one that's had so much success treating people with hepatitis C. Cirillo says he hopes to eventually cure the entire population of the deadly virus. For NPR News, I'm Julio Ochoa in Tampa.

(SOUNDBITE OF ISRAEL MEDINA, SAMPLE MAGIC AND DAVID FELTON'S "GOLDEN HAZE")

SIEGEL: And that story was produced with the USC Center for Health Journalism's national fellowship and Kaiser Health News.

(SOUNDBITE OF ISRAEL MEDINA, SAMPLE MAGIC AND DAVID FELTON'S "GOLDEN HAZE") Transcript provided by NPR, Copyright NPR.