Anthony Martinez, MD: Hello and welcome to this HCPLive® Peer Exchange program titled, Treating Your Patients with Hepatitis C: Addressing Complex Needs with a Simplified Treatment Approach. I’m Dr. Tony Martinez, Associate Professor of Medicine at the Jacobs School of Medicine (and Biomedical Sciences) at the University at Buffalo and Medical Director of Hepatology at Erie County Medical Center in Buffalo, New York. Four of my colleagues are also joining me in today’s discussion. Please each of you introduce yourself.
Tipu V. Khan, MD: (Hello), Tony, I’m Tipu Khan. I am an addiction specialist and family physician, Chief of Addiction Medicine at Ventura County Medical Center, and Program Director of the Addiction Medicine Fellowship. I lead the primary care hep(atitis) C eradication program for our residents there, and I am an assistant clinical professor at the USC (University of Southern California) Keck School of Medicine.
Anthony Martinez, MD: Awesome, welcome… Nancy?
Nancy Reau, MD: Thanks, Tony. It felt great to be here. I am a transplant hepatologist at Rush University Medical Center in Chicago, Illinois, where I am also chief of hepatology.
Anthony Martinez, MD: Excellent. Welcome. Mark?
Mark Sulkowski, MD: Hello, Tony. I’m Mark Sulkowski. I’m at Johns Hopkins (University School of Medicine) in Baltimore, where I serve as medical director of our Viral Hepatitis Center and professor of medicine there.
Anthony Martinez, MD: Excellent. Jordan?
Jordan Mayberry, PA-C: (Hello), Tony. Thanks for having me. I’m Jordan Mayberry. I am a physician assistant in the Digestive and Liver Disease Clinic at UT (University of Texas) Southwestern (Medical Center) at Dallas.
Anthony Martinez, MD: fantastic. Welcome. Our discussion today will focus on screening, diagnosis, and treatment of hepatitis C in a variety of clinical settings, including addiction medicine and primary care. We will discuss simple treatment regimens and some strategies on how to incorporate HCV (hepatitis C virus) care into your clinical practice. welcome everybody. let’s get started. The World Health Organization (WHO) aims to eliminate hepatitis C by the year 2030. Mark, where do we stand on abolition? Are we on the right track?
Mark Sulkowski, MD: Well that’s a good question and it’s a good time to ask it. We are about 7 years away from 2030 and where are we? In 2015, WHO said we want to reduce hepatitis C as a public health threat. We’ve got these great medicines. We can do this. He set 2 goals. First, to reduce the mortality rate by 65%. The second was a reduction in incidence, i.e. new cases, by 90%. where do we stand? Well, if we just focus on the United States, there are some good things there. By treating older individuals with more advanced liver disease, we have reduced the death rate, and in many ways, have achieved that particular goal. Not in every subgroup. In fact, the most recent (data) from the CDC shows that some groups of Americans, particularly African Americans, are still dying at a rate that is far greater than other groups. The second place where we are getting an F grade is on incident. We still have many new individuals becoming infected with hepatitis C at various ages; Not only young people, but everyone above the age of 60 is suffering from Hepatitis C and it is, of course, linked to injection drug use.
Anthony Martinez, MD: When does it seem like we’re on track for annihilation, if we even get there?
Mark Sulkowski, MD: Well, at the current rate of new cases it’s kind of an affinity curve…probably matching the number of people who have recovered with treatment. We’re probably walking on water at best.
Anthony Martinez, MD: So, Tipu, we just heard that maybe we’re not on the right track here and we’ve got treatments that are highly effective, safe, relatively easy to use, (and they’ve) turned out to be really simple. What do you see as some of the obstacles that prevent us from reaching abolition?
Tipu V. Khan, MD: Yes, it is interesting. I think when we think about obstacles, we tend to put them into certain categories. The first category is patient. It is difficult to identify these patients. We’re not doing a very good job at screening. Universal screening guidelines are available. But if we don’t screen them, we won’t find them, right? We won’t be able to connect them with care. So we have to make sure that we are screening people appropriately. Every person 18 years of age or older should be tested at least once, and more frequently if they have persistent risk factors (such as) injection drug abuse. I think when we do that we’ll find that we’re catching these patients more often.
The other thing that I think we’re facing an obstacle to – especially, as Mark was saying, the incidence right now in young drug use patients – (is) we’re finding that they might otherwise. Are healthy and they don’t they don’t engage in health care, and they don’t come to the doctor because they don’t have a lot of other things going on. So I think as a system we need to understand that whenever we catch them in the health care system, whether that could be screening for a medication-assisted treatment program or incarceration… we need to identify them. , should be able to screen them. And add them with care. But I think the next step beyond that, certainly, is at our level as designated providers. We need to understand that there are simplified algorithms out there. Nowadays the treatment of hepatitis C is not the same as it was 15 years ago. And it’s really become a primary care disease now. And we, as primary care physicians, as addiction specialists, must now be leaders in treating this disease. I always tell my colleagues that not everything we do in primary care is sexy, right? We are in this for the long term. But it’s one of the few diseases we can actually treat. We might say, “I want to do therapy for you. “I’ll shake your hand and fix you up and we’ll be done.” So I think we, as providers, as prescribing providers, need to move forward in screening and then understand that the algorithms for treatment are really simple, which is what we’ll cover today.
I think the other big hurdle is systemic. Over the years, we have seen that patients had to go through a lot of hurdles to get treatment. We have to provide restraint. We already have to address a certain level of liver damage (and) provide treatment. Are there other medical comorbidities that make this patient a higher risk for treatment? And more and more states have gotten rid of them, right?…In many states now, you don’t need a specialist to prescribe. You do not need to have co-morbidities. If you have hepatitis C, you should recover. So as we continue to work on this as a nation, as a health care system, we need to focus on the patient to eliminate those other barriers.
The transcript was AI-generated and edited for clarity and readability.
(Tags to translate) World Health Organization (T) Hepatitis C (T) Incidence (T) Injection drug use (T) Epidemiology (T) Barriers to treatment (T) Elimination