The Centers for Disease Control and Prevention estimates that 3.2 million Americans have hepatitis C. And, we believe that only half of those 3.2 million have been screened, leaving millions of people unaware that they have hepatitis C.
So the question is, how can patients and health-care providers work together to increase the screening rate for hepatitis C?
Baby boomers should know that the U.S. Preventive Services Task Force recommends that all people born between 1945 and 1965 have a one-time screening for hepatitis C. This is important because 75 percent of hepatitis C patients are baby boomers. If health-care providers can ensure compliance with this recommendation, then we will be able to catch many of the cases being missed.
For the remaining 25 percent, there are a variety of possible approaches that clinicians and patients can take to increase screening rates.
During Digestive Disease Week® (DDW), the world’s largest gathering of physicians and researchers in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery, my colleagues and I discussed these and other ideas to screen the patients who are being missed. It’s safe to say that the health-care community will need to adopt more than one method to reach our goal of increasing the rate of screening.
Clinicians can educate patients who are at high risk, including those who are current or former intravenous drug users, chronic hemodialysis patients, persons with HIV, and persons with known exposure to the virus. This education can help patients, who believe they are at high risk, to proactively speak with their clinicians.
We can also revise current clinical decision-support mechanisms in electronic health records to prompt health-care providers to screen high-risk patients.
And, then, there is the approach being taken at the University of Alabama at Birmingham. At UAB, clinicians are discussing hepatitis C with all patients coming to the emergency room and screening anyone who doesn’t opt out of the test.
Once identified, hepatitis C patients can now expect cure rates possibly exceeding 90 percent — a rate that was previously unthinkable, according to new research presented this week at DDW.
Hepatitis C is mainly transmitted through blood-to-blood contact. It attacks the liver and can range in severity from something mild that lasts a few weeks to a serious, lifelong illness. In patients with hepatitis C, the liver becomes scarred, which can lead to cirrhosis, and in some cases, liver failure or cancer.
Just 30 years ago, the health-care community basically had only a single weapon, interferon, to fight hepatitis C. Unfortunately, success rates with the drug were very low — only about six percent — because patients found the significant side effects, such as fatigue, anxiety, depression and nausea, too difficult to tolerate.
When ribavirin was added to interferon treatment, success rates climbed, yet only to about 50 percent. Again, the low response rate was mainly due to significant side effects.
The data being presented at DDW focus on new treatments, such as sofosbuvir and ledipasvir as well as investigational drugs. These new regimens are not paired with interferon, making the treatments much more tolerable.
The other highly promising aspect is that these new regimens have been found to be effective in the different subsets of hepatitis C patients — genotypes 1a, 1b, 2 and 3. We’re also seeing the same effectiveness with patients who have never received hepatitis C treatment before, or those who failed previous treatments.
As we continue to improve our screening rates, this ability to cure hepatitis C at such high rates makes this an exciting time for the hepatitis C community — both patients and healthcare providers.
Dr. Jensen is director of the center for liver diseases at the University of Chicago.
Published On: May 07, 2014