Goal to eliminate hepatitis C

transcript

Anthony Martinez, MD: Hello and welcome to the HCPLive® peer exchange program titled “Cure Hepatitis C: Simplified Treatments Addressing Complex Needs.” I’m Dr. Tony Martinez, associate professor of medicine (and biomedical sciences) at the University at Buffalo Jacobs School of Medicine and medical director of the Division of Hepatology at Roylee County Medical Center in Buffalo, New York. Joining me for today’s discussion are four of my colleagues. Please introduce yourselves.

Tipu V. Khan, MD: (Hello) Tony, this is Tip Khan. I am an addiction specialist and family physician, Director of Addiction Medicine at Ventura County Medical Center, and Director of the Addiction Medicine Fellowship Program. I run the primary care hepatitis C eradication program for the residents there, and I’m an adjunct clinical professor at the Keck School of Medicine of USC.

Anthony Martinez, MD: Very nice, welcome…Nancy?

Nancy Rowe, MD: Thank you, Tony. It’s great to be here. I am a transplant hepatologist at Rush University Medical Center in Chicago, IL, where I am also chief of the Division of Hepatology.

Anthony Martinez, MD: Excellent. welcome. mark?

Mark Sukovsky, MD: Hi Tony. I’m Mark Surkoski. I serve as Medical Director of the Viral Hepatitis Center and Professor of Medicine at Johns Hopkins University (University School of Medicine) in Baltimore.

Anthony Martinez, MD: Excellent. Jordan?

Jordan Mayberry, PA-C: (Hello), Tony. Thank you for your hospitality. I’m Jordan Mayberry. I am a Physician Assistant in the Digestive and Liver Disease Clinic at UT Southwestern Medical Center (Medical Center) at Dallas.

Anthony Martinez, MD: excellent. 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 options as well as some strategies on how to incorporate HCV (hepatitis C virus) care into clinical practice. welcome everybody. let’s start. The World Health Organization (WHO) aims to eliminate hepatitis C by 2030. Mark, where do we stand in terms of elimination? Are we on track?

Mark Sukovsky, MD: This is a great question and now is a good time to ask it. We are about 7 years away from 2030, where are we now? Back in 2015, WHO said we wanted to reduce the public health threat of hepatitis C. We have these great drugs. We can do this. They set 2 goals. First, the mortality rate is reduced by 65%. The other is a 90% reduction in incidence (i.e. new cases). Where do we stand? Well, if we just look at the United States, we see some good things. By treating older adults with more advanced liver disease, we reduce mortality and achieve that specific goal in many senses. Not in every subgroup. In fact, the latest data from the CDC shows that certain groups of Americans, especially African Americans, are still dying at much higher rates than others. Another place where we get an F grade is in incidence. We still have too many new infections in people of all ages with hepatitis C; it’s not just young people, people all the way up to over 60 are getting hepatitis C, and that’s certainly linked to injecting drug use.

Anthony Martinez, MD: If we do reach the elimination goal, when will we reach the elimination goal?

Mark Sukovsky, MD: Well, it’s kind of like the affinity curve for new cases right now…maybe matching the number of people cured by treatment. The best we can do is stand still.

Anthony Martinez, MD: So, Tip, we just heard, maybe we’re not on the right track, but we have treatments that are highly effective, safe, relatively easy to use, (and) really (have become) simple. What do you think are some of the barriers that are preventing us from achieving elimination?

Tipu V. Khan, MD: Yes, it’s interesting. I think when we think about obstacles, we sort them into categories. The first category is patience. It is difficult to identify these patients. We don’t do a good job of screening. Universal screening guidelines already exist. But if we don’t sift for them, we won’t find them, right? We cannot relate them to care. So we need to make sure that people are properly screened. Everyone 18 years or older should be screened at least once, or more frequently if there are ongoing risk factors (such as injecting drug use). I think when we do that, we’ll find that we’ll see these patients more frequently.

I think the other thing that we’re encountering – especially, as Mark said, what’s happening with young drug addicts right now – is we find that they’re otherwise healthy, but they don’t do that they don’t Working in health care and not going to the doctor because they don’t have a lot else to do. So I think as a system we need to understand that every time we capture them in the health care system, maybe in a medication-assisted treatment program or incarceration screening… we should be able to identify them, screen them, and put them They are linked to care. But I think the next step beyond that is certainly where we are as prescribers. We need to realize that there are some simplified algorithms. Treatment for hepatitis C is different today than it was 15 years ago. Now it has really become a primary care disease. We, as primary care physicians, as addiction specialists, should now be the leaders in treating this disease. I always tell my colleagues, there’s not a lot that’s sexy about what we do in primary care, right? We’re in it for the long haul. But it’s one of the few diseases that we can actually cure. We can say, “I’ve got to find a cure for you. I’m going to hold your hand, let you get well, and we’re done with this.” So I think we, as providers, as prescribers, need to take Acting on screening and then understanding the algorithm is very simple for treatment, which we’ll cover today.

I think the other big obstacle is systemic. Over the years, we have noticed that patients have many barriers to overcome when accessing care. We must stay awake. We must provide a certain level of liver damage and adhere to treatment. Are there other medical comorbidities that place this patient at higher risk for treatment? More and more states are already getting rid of these, right? … Now in many states, you don’t need a specialist to write a prescription. You don’t need comorbidities. If you have hepatitis C, you should be cured. So as we continue to grapple with this as a country, as a health care system, we need to focus on… patient-centeredness to remove other barriers.

Transcript generated by artificial intelligence and edited for clarity and readability.