Hepatitis C: Risk and Cohort Screening Advised

Posted Oct. 26, 2014:
By Laura Selby

hepatitis.jpgThe availability of efficacious, all-oral hepatitis C treatment options has changed the landscape of caring for patients with the virus. Bill Carey, MD, is a Cleveland Clinic physician who's board certified in internal medicine and gastroenterology. "Basically, what we're talking about is the ability to cure hepatitis C," he told attendees. Because the virus is now highly treatable and there aren't enough hepatitis C-treating providers, Dr. Carey said, it's critical for all physicians to be involved in screening, evaluation and treatment of potential hepatitis C patients.

Which Patients Can Non-Specialists Treat?

For those patients who are "ideal" for non-specialists to treat, Dr. Carey said, treatment is easy and effective, monitoring isn't time-consuming and severe side effects are infrequent. But some hepatitis C patients should be referred to specialists, he advised, including those with cirrhosis, patients who are pre-and post liver transplant, those who've previously been treated for the virus, those who are hepatitis C-HIV coinfected, and cases where ribavirin is needed.

Risk and Cohort Screening

In the past, Dr. Carey noted, screening efforts were sometimes focused on patients with known risk factors, like intravenous drug use. However, he said, because 70% of those infected were born between 1945-1965, the CDC and USPTF recommend physicians perform both risk-based and cohort screening. An added benefit of cohort screening is that it can help identify potentially infected patients who may not self-report accurately. "I see patients who are bank presidents and so on who conveniently have forgotten they used IV drugs or cocaine once or twice in the 70s," Dr. Carey noted dryly.

Reimbursement Challenges

But Dr. Carey explained that although all-oral therapy options like sofosbuvir + ledipasuir are highly effective, their cost can be "staggering" for patients. "The biggest hurdle these days is not can we treat and eradicate hepatitis C, but can we get insurance companies to reimburse," he stated. "One can only hope that with newer drugs coming online, there will be [downward] pressure on cost." New oral treatment options are expected to enter the marketplace in late 2014 or early 2015.

But overall, it's an exciting time in the fight against hepatitis C. Dr. Carey shared a letter from a patient who had seen significant improvement in her viral counts after two weeks of treatment and experienced only mild side effects. She wrote that she felt she had been given a second chance at life, telling Dr. Carey, "This is the best present I could ever receive."