Hepatitis C Doctor Profile

When Lynn Taylor, MD, was in medical school, she studied under some of the most prominent HIV researchers at the time. They taught Dr. Taylor, who is now one of Rhode Island’s leading hepatitis C doctors, a lesson she finds invaluable today: “Listen to, and focus on, the research.”

Taylor’s mentors were speaking from experience. During the early years of the HIV epidemic, doctors struggled to get HIV treatment for people who were unhoused or injected drugs. Taylor has found that people with hepatitis C who are in similar situations face the same biases.

“It was thought that ‘those people’ wouldn’t be able to adhere to their medication,” Taylor explains.

But, Taylor’s mentors insisted on treating everyone who had HIV, regardless of whether they were using substances or had unstable housing. What they found was that, with enough support, most people were able to keep taking their medication successfully.

In time, there was research to help support this anecdotal evidence. A study published in Clinical Infectious Diseases, for example, found that 69 percent of people experiencing homelessness and living with HIV in San Francisco were able to stick to their treatment regimen.

“Those early assumptions about people with HIV/AIDS were wrong and unfair,” says Taylor.

Because of this, for the past two decades, Taylor has fought to bring hepatitis C treatment to those who need it most, including people who inject drugs.

Early Hepatitis C Treatment: The Interferon Era

In 2001, Taylor founded one of the country’s first co-located HIV/epatitis C co-infection programs, at Brown University’s The Miriam Hospital, in Providence, Rhode Island. At the time, the only treatment available for hep C was a medication called interferon with or without ribavirin. It was far from perfect: The drug cured only about 1 in 10 people infected with the hepatitis C virus in the U.S. and triggered flu-like side effects.

Interferon also increased the risk of depression. Taylor prescribed it anyway, making her a bit of an outlier among doctors who treated hepatitis C. That’s because the virus was largely spread through the use of injection drugs, and research showed that up to 30 percent of people who injected drugs had a depressive illness.

Other hep C doctors weren’t as likely to prescribe interferon for other reasons: They believed that interferon would worsen a person’s substance use problem or their symptoms of depression. They also worried that people who injected drugs wouldn’t be able to stick to the treatment regimen, which might eventually lead to a drug-resistant hepatitis C virus.

There was also a prevailing attitude that people who injected drugs simply “weren’t worthy” of being treated, she says.

“Other healthcare workers thought I was doing more harm than good,” Taylor says.

Those fears and biases turned out to be unfounded, she says. Eventually, doctors realized that stopping interferon wouldn’t lead to a drug-resistant hepatitis C virus, and research showed that people who injected drugs and those with a history of mental illness were just as likely to be cured as people who didn’t use injection drugs.

Modern Hepatitis C Treatments: Direct-Acting Antivirals

In 2013, when the U.S. Food and Drug Administration approved the second generation direct-acting antiviral (DAA) sofosbuvir, interferon became nearly obsolete as a treatment for hepatitis C. DAAs were, in Taylor’s words, a “game changer” — and are now able to cure about 99 percent of people who hepatitis C if they’re taken correctly.

“It was lifesaving,” she says. “We could avert premature death … and avoid interferon’s [side effects].”

Almost immediately, though, most state Medicaid programs limited who would qualify for the DAAs, which was a major blow to many of Taylor’s patients. People who inject drugs are disproportionately on Medicaid, she explains.

This meant that, in Rhode Island, the only people who could receive DAAs were those who had advanced fibrosis, had an undetectable HIV load, could access a specialist physician, and had been sober for at least six months. The last restriction effectively denied care to people who used drugs.

“It was a huge blow,” says Taylor. “We were frantically trying to treat the people with advanced scarring as fast as we could, to keep them from getting liver cancer or developing liver failure, all while new infections were being acquired.”

Her frustration mounting, Taylor published a state-by-state analysis of Medicaid restrictions in the Annals of Internal Medicine with colleagues including Soumitri Barua, from Brown University, and Robert Greenwald, a lawyer from Harvard University. This study led to a partnership with the Harvard Center for Health Law and Policy Innovation, an organization that offered to assist with lawsuits against any state Medicaid program that imposed unnecessary restrictions on DAAs.

In February 2018, Taylor initiated a collaborative effort with other people in Rhode Island to bring a lawsuit against Rhode Island Medicaid, hoping to remove the DAA restrictions that violated Medicaid law.

“There was no evidence people who inject drugs can’t be treated,” she says. “It was a strategy to deny high-priced medications to people and save money in the short term, but it led to more spending on hepatitis C in the long run.”

“Just because you can’t stop using fentanyl or heroin or cocaine doesn’t mean you don’t care about your health,” Taylor says.

The effort paid off: In July 2018, Rhode Island Medicaid removed many restrictions, including fibrosis status and the six-month period of sobriety.

The Future of Hepatitis C Treatment and Care

Much has changed since Taylor began treating people with hepatitis C. As of 2023, the Medicaid program in every state except Arkansas has removed the fibrosis restriction, and forty states have dropped the sobriety restriction.

And yet, the United States has a long way to go to eliminate the virus. The World Health Organization has set a goal to reduce new hepatitis infections (mainly hepatitis B and C) among its member states by 90 percent by 2030, but the United States is falling behind. According to a report published in June 2023 by the Centers for Disease Control and Prevention, the majority of Americans with hepatitis C have not been cured.

This is partly because the United States hasn’t been as proactive in managing addiction as other countries. Switzerland and Portugal, for example, have taken a medical approach to drug use by increasing access to methadone and helping people who inject drugs get treatment, rather than incarcerating them for addiction. Such measures have “changed things dramatically, and that is helping to combat the epidemic,” she says.

By contrast, in many parts of the United States, people who inject drugs don’t have access to medications, such as methadone, that can treat opioid use disorder, or they can’t find sterile syringes, which can help reduce the infection rates of hepatitis C.

Despite the setbacks, Taylor is hopeful about the future. Without a vaccine, it’s unlikely that the hepatitis C virus will ever be fully eradicated, but with the right health programs in place — namely, hepatitis C treatments, syringe access programs, and medications to treat opioid addiction — “we can drastically reduce the number of people living with hepatitis C,” she says.