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Peers and Perspectives

1rem

, where we delve into some of the social factors that create and widen healthcare disparities.

In honor of World Hepatitis Day, we interviewed Carl Schmid, executive director of the 

, about the persistent challenges in the fight against 

Schmid acknowledged there are many diseases and health concerns plaguing the world right now, but World Hepatitis Day is a chance to pause and recognize “we still have hundreds of millions of people with hepatitis right now, and it’s an infectious disease.”

Schmid himself is living with chronic hepatitis B, and thus, “This issue is personally very important to me.”

The different types of hepatitis disproportionately affect different populations. Schmid notes that in the US, homeless people are often most affected by hepatitis A, while Asian Americans make up the majority of hepatitis B cases. In the US, all people are recommended for hepatitis B vaccination at birth; immigrants who may not have been vaccinated have a higher risk for hepatitis B.

Even though we have a vaccine for hepatitis B, and viral hepatitis treatments are better than ever, the opioid epidemic is significantly increasing hepatitis infection by injection drug use. “We’re seeing more and more younger people, and more and more women who are contracting hepatitis C,” Schmid said.

“Every 30 seconds,” Schmid says, “someone is dying of hepatitis, and the sad thing is people don’t even know about it.”

“Like HIV, there’s so much stigma…a lot of people feel shame, and they don’t talk about it,” Schmid said, pointing out that this stigma leads to many unnecessary deaths.

Schmid noted that the hepatitis testing recommendations have been changed, and now every person between 18 and 79 years of age should be tested, which should reduce the stigma.

“It all comes down to testing,” he emphasized.

Proper surveillance for hepatitis is another area that is sorely lacking. “We don’t even have enough money to do proper surveillance of hepatitis,” Schmid said, “We know surveillance is so important for infectious diseases.”

The HIV+Hepatitis Policy Institute is a Washington, DC-based policy and advocacy organization for HIV and viral hepatitis issues. They are currently working with Congress to help pass the Biden Administration’s push for more funding.

Schmid said we have a long way to go in the fight against hepatitis: “This is an infectious disease, remarkably, that can be cured,” but, “We need more resources.”

Missed Episode 5 of Contagion Community? 

Listen in on the conversation and feel free to offer your feedback on this episode, interest in participating in the podcast, or suggest ideas for future episodes. Please email your correspondence to Nina Cosdon: 

What steps need taken to end viral hepatitis by 2030? “It all comes down to testing,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute.

World Hepatitis Day: Where Do We Go From Here?

Social determinants, a legacy of distrust, and inequities have all been challenges for people of color in the delivery of health care. And these factors have translated to the administration of 

The university hosts the biggest vaccination site in its county, San Bernadino. However, there is low representation of Black vaccinees. Abdul-Mutakabbir and faculty at Loma Linda worked with leaders from local Black churches to get the word out and communicate about the availability and benefits of the COVID-19 vaccine.

“From February 1 until April 30, 2021, 24,808 individuals were vaccinated in the LLU mass clinic with a first dose (Pfizer or Moderna) or single dose (Janssen) of a COVID-19 vaccine, however, only 908 (3.7%) were Black vaccinees. Contrastingly, the LLU remote site clinics vaccinated 1542 individuals with a first or single dose of a COVID-19 vaccine. Of those vaccinees, 675 (44%) were Black,” Abdul-Mutakabbir and coauthors wrote in their poster.

Along with protection against COVID-19, Abdul-Mutakabbir makes the point that preventative measures such as vaccines can help avoid hospital stays and subsequent health care associated infections and antimicrobial resistance. She believes vaccination goes hand-in-hand with antimicrobial stewardship.

Hear what vaccine equity means to Abdul-Mutakabbir, and the vaccine drive in which she was involved.

Missed Episode 1 of Contagion Community? 

Listen in on the conversation and feel free to offer your feedback on this episode, interest in participating in the podcast, or suggest ideas for future episodes. Please email your correspondence to Nina Cosdon: ncosdon@mjhlifesciences.com

In this latest episode of Contagion Community, we interview Dr. Jacinda Abdul-Mutakabbir about vaccine equality vs vaccine equity as well as her experience on a COVID-19 vaccine drive to increase vaccinations in communities of color.

Vaccine Equality vs Equity with Dr. Jacinda Abdul-Mutakabbir

The country’s program yielded screening and treatment in almost two thirds of the identified at-risk population. 

Israel’s Hepatitis C Elimination Program is Making Strides 

The ALLIANCE Phase III study demonstrated that Biktarvy, a TAF-based regimen, achieved sustained virologic suppression in adults with HIV/HBV co-infection.

Biktarvy Shows Long-Term Efficacy and Safety in HIV/HBV Coinfection After Three Years

Atea Pharmaceuticals has been reporting data on its combination of bemnifosbuvir and ruzasvir as a potential treatment for the virus.

Investigational Combination Hepatitis C Therapy Demonstrates a 97% Sustained Virologic Response

The monoclonal antibody’s manufacturer, Bluejay Therapeutics,  also reports in its phase 2 clinical trial there was up to a78% combined virologic response and ALT normalization as monotherapy.

Investigational Hepatitis D Monoclonal Antibody Achieves 100% Virologic Response 

Participants who used fentanyl were 1.64 times more likely to experience HCV seroconversion compared to those who did not.

Study Finds Association Between Illicit Fentanyl Use and Increased Risk of Hepatitis C

Arbutus CEO Michael McElhaugh discussed trial results showing that a combination of imdusiran, an RNAi therapeutic, and pegylated interferon alfa-2α can achieve a functional cure in chronic hepatitis B patients.

Imdusiran for Chronic Hepatitis B Achieves Functional Cure in 50% of Patients

Arbutus Biopharma Corporation has announced breakthrough data from its IM-PROVE I Phase 2a clinical trial, demonstrating that a combination of imdusiran (AB-729), an RNA interference (RNAi) therapeutic, and a short course of pegylated interferon alfa-2α (IFN) can achieve a functional cure in patients with chronic hepatitis B virus (cHBV) infection. The data, showing up to 50% of patients achieving a functional cure, will be presented at The Liver Meeting® 2024, hosted by the American Association for the Study of Liver Diseases (AASLD) on November 18.

In our interview with Michael J McElhaugh, interim president and CEO and director of Arbutus Biopharma, he discussed the promising results from the IM-PROVE I trial. “The data from this study reveal significant long-term potential for imdusiran in combination with interferon as a pathway toward a functional cure for cHBV,” McElhaugh said. “This combination has the potential to change the treatment landscape for Hepatitis B.”

The IM-PROVE I trial included HBeAg-negative patients with suppressed HBV who received six doses of imdusiran alongside 24 weeks of interferon, in addition to ongoing nucleos(t)ide analogue (NA) therapy. Results revealed that 50% (3/6) of patients with baseline hepatitis B surface antigen (HBsAg) levels less than 1000 IU/mL achieved a functional cure, defined as sustained HBsAg loss and undetectable HBV DNA for 24 weeks after stopping all treatments. Overall, 25% (3/12) of patients across the cohort achieved a functional cure.

According to McElhaugh, the IM-PROVE I study focused on evaluating the combination of imdusiran and interferon in e-antigen-negative patients who had previously been chronically suppressed with nucleoside analogs, the current standard of care. The trial tested four different treatment regimens to evaluate how well imdusiran could reduce surface antigen levels, a key marker of the virus, in combination with interferon over periods ranging from 12 to 24 weeks.

“The primary goal of this trial was to reduce surface antigen levels with imdusiran,” McElhaugh explained. “After the interferon phase, we paused all treatments and monitored patients for 24 weeks without therapy, which is the regulatory definition of a functional cure. This means Hepatitis B DNA is undetectable, and surface antigen is lost or reduced to below the limit of quantification.”

The results from the study were groundbreaking, particularly in the group that received imdusiran continuously in combination with 24 weeks of interferon. In this cohort, 25% of patients achieved a functional cure, a result McElhaugh calls “one of the best seen in the field.” Even more notable was the response rate in patients with baseline surface antigen levels below 1,000 IU/mL, where 50% of patients achieved a functional cure.

“This patient population is key,” McElhaugh emphasized. “Hepatitis B is a major global health issue, but even focusing on a subset—such as those with lower baseline surface antigen levels—can make a big difference. Achieving a functional cure in half of these patients is a very promising result.”

When asked about factors that influenced which patients were more likely to achieve a functional cure, McElhaugh highlighted baseline surface antigen levels as the most significant predictor. Patients with surface antigen levels below 1000 IU/mL had a markedly higher chance of success compared to those with higher levels.

“We saw that patients with lower surface antigen levels were more likely to achieve a functional cure,” McElhaugh noted. “That’s a critical insight for optimizing treatment regimens moving forward.”

Comparing imdusiran to other RNAi therapies in development for Hepatitis B, McElhaugh shared that Arbutus' product stands out due to its ability to induce immune activation. Unlike other siRNA treatments, which have largely been considered similar in their mechanisms, imdusiran has demonstrated the capacity to prime the immune system and activate T-cells during the initial treatment phase.

“This immune activation makes imdusiran different from other siRNAs,” McElhaugh explained. “It creates a better environment for immune-modulatory treatments like interferon to work more effectively. These differences, such as the structure and delivery mechanisms of the siRNA, contribute to the better outcomes we’re seeing.”

Looking ahead, McElhaugh revealed that Arbutus is eager to move imdusiran into later-stage development as quickly as possible. The company is currently in discussions about the best path forward, including engagement with regulatory agencies to ensure the swift progression of the therapy. “Our goal is to maximize the functional cure rates we’ve seen with imdusiran and bring it to patients as soon as we can,” McElhaugh said.

Although the AASLD conference had just kicked off, McElhaugh expressed optimism about the reception of the data so far. “We’ve had a packed schedule of meetings, and everyone we've spoken to has been very impressed with the results,” he shared. “It’s been a rough day in the markets, but we’re feeling confident about where we stand with imdusiran.”

Press Release. Arbutus’ Imdusiran Achieves Functional Cure in cHBV Patients when Combined with a Short Course of Interferon. Arbutus Biopharma. November 15, 2024. Accessed November 18, 2024. 

https://investor.arbutusbio.com/news-releases/news-release-details/arbutus-imdusiran-achieves-functional-cure-chbv-patients-when

Conferences

In the second part of their interview, Debika Bhattacharya, MD MSc, and Su H. Wang, MD, MPH, FACP, continue the conversation around the difficulties of getting people into care

The Challenges of Hepatitis B Clinical Care Within Underserved Communities

Individuals who contract hepatitis B are often living on the margins and may not be in a position to get the proper medical care needed. Fortunately, both new US federal and global guidelines are looking to address hepatitis B and get more people into the continuum of care. The overarching public health goals with the new hepatitis B guidelines are to make significant changes to HBV testing and clinical care including increasing vaccinations, extending universal screening to everyone at least once during a lifetime for all adults 18 years of age and older, reducing the number of new infections, and getting those patients who have contracted the disease the therapy to address their infections.

Debika Bhattacharya, MD MSc, clinical professor, David Geffen School of Medicine, University of California, Los Angeles (UCLA), believes the new universal hepatitis B screening guidelines is going to be a difference maker. “The universal screening guidelines that have been developed for hepatitis B are really going to help communities that don't necessarily see physicians or have access to health care, even in the United States on a regular basis, because with the previous guidelines, you were asking risk-based questions and trying to risk stratify persons as to whether or not they needed Hepatitis B screening. Now we're doing screening for everybody, so that allows us to serve more and to screen more.”

“We're really hopeful that primary care providers can now take on hepatitis B care with the simpler guidelines,” said Su H. Wang, MD, MPH, FACP, medical director, Viral Hepatitis Programs & the Center for Asian Health at the Cooperman Barnabas Medical Center, RWJBarnabas Health. “So in lower resource countries, people are not going to easily able to easily find a hepatologist, or a GI doctor, or infectious disease doctor. And so we want to be able to empower frontline clinicians to be able to take on hepatitis B care.”

’s conversation with Bhattacharya and Wang discuss the new measures as well as the role of interdisciplinary collaboration in developing the guidelines.

To watch the first installment about hepatitis B guidelines, check out their interview 

In the second part of their interview, Debika Bhattacharya, MD MSc, and Su H. Wang, MD, MPH, FACP, continue the conversation around the difficulties of getting people into care, and what the new hepatitis B guidelines hope to improve in this area.

Debika Bhattacharya, MD MSc, and Su H. Wang, MD, MPH, FACP, provide important insights on the latest in hepatitis B (HBV) clinical care.

Understanding the Updated Universal Hepatitis B Screening and Treatment Guidelines

Last year, the US federal government updated the screening and treatment guidelines for hepatitis C. And in a continuation of trying to reduce these blood-borne diseases, US federal and global guidelines are looking to address hepatitis B. The overarching public health goals are to make significant changes to HBV testing and clinical care including increasing vaccinations, extending universal screening to everyone at least once during a lifetime for all adults 18 years of age and older, reducing the number of new infections, and getting those patients who have contracted the disease into the continuum of care.

“The CDC is now recommending universal screening for hepatitis B,” said Debika Bhattacharya, MD MSc, clinical professor, David Geffen School of Medicine, University of California, Los Angeles (UCLA). “Remember that happened for hepatitis C…but now we've updated that to now include hepatitis B testing, and that includes a triple panel test, so that's a surface antigen, core antibody and surface antibody test. The other really important point to say is that in addition to universal screening, we're also now recommending universal vaccination, by and large, of hepatitis B, and those are new and I think really important for providers to be aware of.”

Su H. Wang, MD, MPH, FACP, medical director, Viral Hepatitis Programs & the Center for Asian Health at the Cooperman Barnabas Medical Center, RWJBarnabas Health points out that although the World Health Organization has an ambitious goal to try and eliminate hepatitis B as a public health threat by 2030, there is still a lot of ground to make up.

“In terms of reducing hep B as a public health threat, and we've got huge gaps, like only 13% of people with hep B have been diagnosed, and less than 3% are on treatment. So it's really important to do universal screening and universal vaccination to really help close those gaps,” Wang said.

They agree the idea of changing the criteria from risk-stratified questions to decipher which patients should be tested for HBV to universal screening simplifies the matter and can work towards getting more individuals into the continuum of care.

“We're at such a small amount of people who've been treated, that there is a push and need for us to really simplify the guidelines,” Wang said. “And I think we're seeing that the guidelines were quite complex and very lab based in terms of trying to phase people based on E antigen, viral load, abnormal alanine aminotransferase (ALT), and a lot of people just never got to the point where they had actually gotten all the tests and were being followed and being staged, and a lot of people were being lost to follow up.”

Reference
Evolving Hepatitis B Treatment Guidelines and Implications on Practice: A Case-Based Panel Discussion. Presented at IDWeek 2024. October 16-19, 2024. Los Angeles, CA.

Danjuma Adda on WHO's efforts against Hepatitis B and his call for global vaccination and treatment efforts.

Hepatitis B in Focus Bridges the Gap Between Policy and Implementation in Vaccine Coverage

Danjuma Adda, MPH, FIMS, Dip-IMS, is the past president of the World Hepatitis Alliance and a fellow with the Aspen Voices Fellowship. He is the founder of Appreciate You Organization in Nigeria, which works to improve access to hepatitis testing and increase awareness about the disease. Ida is also living with HBV.

Chronic HBV infection remains a significant global health challenge, leading to approximately 1.1 million deaths in 2022, primarily from cirrhosis and hepatocellular carcinoma, according to WHO. In 2022, an estimated 254 million people worldwide were living with HBV, with the highest prevalence in the African and Western Pacific regions, where 65% of these cases are found.

“There has not been any significant improvement in the diagnosis and treatment of hepatitis B. The prevalence of hepatitis B is alarming, with the disease claiming over 270,000 lives annually in Africa. The rate of diagnosis is dire; only about 3% of hepatitis cases are diagnosed, and merely 2% of those diagnosed receive treatment.”

The primary transmission routes of HBV are from mother to child at birth and through horizontal household contact. Despite the severity of the disease, there has been notable progress in preventing perinatal HBV transmission through universal infant vaccination programs. The administration of a hepatitis B vaccine within 24 hours of birth has been shown to be 90-95% effective in preventing the infection and has significantly reduced the incidence among children. However, global coverage of this birth-dose vaccination is still low at 45%, and even lower in the WHO African region at 18%.

“The WHO recommends that newborns should receive the HBV vaccine within 24 hours of birth, or as early as possible. This is a critical measure to prevent new infections and it's important to remember that this is a cancer-preventing vaccine. To ensure all babies are vaccinated, we need to strengthen immunization systems so that these vaccines are readily available, especially in delivery rooms, not just outside where access can be limited after business hours or on weekends. It's crucial that the vaccines are accessible exactly where and when the babies are born.”

For those already living with HBV, treatments such as tenofovir or entecavir have been highly effective in slowing the progression of liver disease and reducing the incidence of liver cancer, improving long-term survival rates. A substantial gap in diagnosis and treatment persists only 13% of those with HBV were diagnosed in 2022, and a mere 3% received treatment.

“To ensure all babies are vaccinated, we need to strengthen immunization systems so that these vaccines are readily available, especially in delivery rooms, not just outside where access can be limited after business hours or on weekends. It's crucial that the vaccines are accessible exactly where and when the babies are born.”

Achieving the WHO's elimination goals, which aim for 90% testing coverage and 80% treatment coverage, will require a significant overhaul of the current approaches to diagnosing and treating HBV. This includes simplifying treatment criteria, diagnostic methods, and care pathways to enhance access to vital testing and treatment services.

Easterbrook P, Luhmann N, Bajis, et. al. WHO 2024 Hepatitis B Guidelines: An Opportunity to Transform Care.

. Published April 10, 2024. Accessed April 12, 2024. DOI: 

https://doi.org/10.1016/S2468-1253(24)00089-X

Hepatitis B Virus (HBV) Bridges Gap Between Policy and Implementation in Vaccine Coverage

The first-in-class entry inhibitor delivered therapeutic benefits over a long study period for patients with chronic infection. 

Bulevirtide Demonstrates Efficacy, Safety for Hepatitis D Treatment

For patients who have chronic hepatitis Delta (HDV), which is the most severe form of viral hepatitis, the infection can often come with poor prognosis and high rates of mortality. And combined with the possible coinfections such as hepatitis B (HBV) and HIV, disease management can be extremely difficult.

“What we know is hepatitis delta prevalence in people living with HIV is actually higher than in people who do not have HIV,” Anu Osinusi, MD, vice president, Clinical Research for Hepatitis, Respiratory and Emerging Viruses, Gilead, said. “And so because of the common routes of transmissions of these diseases, HIV, hepatitis B, and hepatitis Delta, people who have triple infections, what we also know from the data is that there is a higher rate of liver-related outcomes such as developing cirrhosis, decompensated liver disease, liver cancer...larger rates of the need for liver transplantation and overall death, compared to individuals who just have hepatitis B or hepatitis D.”

With the potential severity of chronic hepatitis D and the coinfections and limited treatment options, there is an unmet need for therapies. Bulevirtide (Hepcludex, Gilead) is a first-in-class entry inhibitor that was approved in the European Union for chronic HDV infection in HDV RNA positive adult patients with compensated liver disease. The therapy is an investigational treatment in the United States. 

“What bulevirtide does is it essentially binds to and then inactivates the NTCP receptor, which then has the goal of preventing new infections in the hepatocytes, and then inhibits the propagation of hepatitis Delta itself,” Osinusi said.

At last week’s Conference on Retroviruses and Opportunistic Infections (CROI) in Denver, CO, data was presented on bulevirtide in regards to those with chronic hepatitis D and also included results on 2 patients who had HIV, hepatitis B, and hepatitis D.




In this study, 150 participants with chronic hepatitis D were randomized (1:1:1) into 3 arms including Arm A, which was no active anti-HDV treatment for 48 weeks, followed by bulevirtide 10mg/d for 96 weeks (n=51), and Arms B or C: immediate treatment with bulevirtide at 2 mg/d (n=49) or 10 mg/d (n=50), respectively, each for 144 weeks, with follow-up of 96 weeks after end of treatment. Efficacy was measured by combined (undetectable HDV RNA or ≥2 log10 IU/mL decline from BL and ALT normalization), virologic and biochemical response rates.

“At week 96, 39% to 56% of patients responded with substantially reduced levels of HDV RNA and with normal levels of the liver enzyme alanine aminotransferase, a key marker of liver health. Through 2 years of treatment, bulevirtide was safe and well tolerated,” the study authors wrote.

Osinusi explained that for some participants it may have taken longer time to see a therapeutic benefit.

“Even in the patient participants who didn't have a virologic response at week 24, over time, many of those participants actually go on to have this improved response at week 96,” she said.

For the 2 individual patients in the subset who had HBV/HDV, they also saw a benefit. “At week 96, both patients achieved a combined response (virologic and ALT normalization) as well as improvements in HBV DNA, platelet levels, and liver stiffness measurements,” the investigators wrote. “Neither patient required changes to their anti-HIV regimen nor did they experience serious [adverse events] AEs related to [bulevirtide] BLV.”

 spoke to Osinusi who offered further insights on the study and the therapy.




Wedemeyer H, Aleman S, Brunetto M, et al. Efficacy and Safety of Bulevirtide 2 mg or 10 mg for 96 Weeks in Chronic Hepatitis Delta, Including in 2 Patients With HIV/Hepatitis B Virus/Hepatitis Delta Virus. Poster #735 presented at CROI 2024. March 3-6, 2023. Denver, CO.



2023 year in review

As we close out 2023, it is a time to reflect on the major developments and approvals of some important therapies and vaccines. For example, the approval this year of 4 RSV immunizations will certainly be beneficial in the years ahead. In fact, we created a series around the topic titled, 

, which is a collaborative project with our partners 

 to discuss these significant approvals and how clinicians are counseling patients and families on these immunizations. 

In addition, 2023 saw the approval of antimicrobials, the continued development of rapid diagnostics, and the ongoing evolution of concepts such as 

Our Editor-in-Chief Jason Gallagher, PharmD, FCCP, FIDP, FIDSA, BCPS, offered some insights on a variety of topics including what he felt was the most unique development of the year, the FDA approval of Innoviva’s antibiotic, sulbactam-durlobactam (Xacduro). The antibiotic was 

 back in May and is indicated for treatment of hospital-acquired bacterial pneumonia (HABP) and ventilator-associated bacterial pneumonia (VABP) caused by 

It is this antibiotic that can serve as a microcosm of the industry and the development of these essential therapies. The scope of the indication is limited, and behind this is the question of whether this can be seen as economically viable in an antimicrobial market that has inherent challenges from development to profitability. Gallagher is intrigued by the approval of this therapy and has 

 about it.

“And among the things that's interesting about that to me is honestly, whether it can be commercially successful,” said Gallagher. “I hope it is. I think it's a wonderful new drug, or a revision of an old drug, to our armamentarium. But, if you asked clinicians for years in infectious diseases what they would like to see as that ideal next drug, I think a lot of people would tell you a targeted agent active against highly resistant gram negatives. Most people would probably say 

 and ideally oral, but would such an [agent] really be commercially successful?”

, Gallagher also weighed in on RSV immunizations, the evolution of COVID-19 monovalent vaccines, and the reemergence of the investigational antibiotic, ceftobiprole, and its possible approval in April 2024.



New and novel antimicrobials remain at a crossroads as the path to development and economic viability continue to be serious challenges. Our Editor-in-Chief weighs in on this topic and some of the other most significant ones from this past year.

2023: The Year in Infectious Disease

The panelists discuss the importance of the role of task shifting in Hepatitis C care.

Task shifting in HCV care

 It sounds like there [are] barriers on 3 levels––the patient, provider, and the system itself can be difficult to navigate, right? And one term that we frequently hear about is 

. And that’s a concept that can help us to overcome some of those barriers. Jordan, can you define that? What exactly does that mean? And how do you see that being important to…clos[ing] some of these gaps?

Absolutely. Well what we know is that APPs [advanced practice providers], our nurse practitioners and our PAs [physician assistants], are valuable members of the health care system. And…now about 75 % of patients that have HCV [hepatitis C virus] are being managed by APPs. So I think it’s very important that we are educating our APP colleagues about this disease state, about these great and easy-to-use medications, so that we can continue to screen and treat these patients with the help of our APP colleagues.

 So really they’re an essential component to achieve elimination. I mean, this is where the bulk of patients [are] being screened, [receiving a diagnosis, and being] actually treated, so we really need that support from the APP colleagues to…get this done. Tipu, do you see a similar role for task shifting within the addiction medicine community?

 Yes. This gets me really excited. I love this topic. The incidence, as we were [discussing] with the data with Mark, is young drug-using patients that are injecting drugs are really pushing the incidence of hep[atitis] C right now. And again, these patients are healthy. They’re not going in for health care elsewhere, but where do they go? They go to a methadone clinic. They go to their MAT [medication-assisted treatment] provider, the primary care doc[tor], to get their medications for opioid use disorder.… So when we see them there for that, that’s a perfect opportunity for us to screen and treat them. In my eyes, I really think that addiction medicine is [at] the forefront of hep[atitis] C treatment. As a fellowship director, I train all…my fellows [to recognize] that when you’re treating your patients for whatever substance use disorder they have, you need to be updated on the guidelines for screening, but you need to be comfortable with management because these patients may not go to the primary care doc[tor]. They may not go to a GI [gastrointestinal] doc[tor] or hepatologist or an infectious disease specialist. They may only come to you to get their buprenorphine prescription or their other MOUD [medications for opioid use disorder].… So when you [have] them, you’ve got to feel comfortable treating [them]. And I do think that colocalization of treatment under the same roof by addiction medicine for hep[atitis] C is going to be important in eradication.

 Tipu, I’ll pose this question to both you and Jordan. Do you see hep[atitis] C as serving as a gateway to deal with some of their other comorbidities, whether it’s addiction medicine or addiction comorbidity, or if they have some of the primary care comorbidity, do both of you see that hep[atitis] C leading to potentially dealing with some of these other issues?

I think it’s a 2-way street, actually.… It goes both ways. In my practice, we’ve had a lot of patients that come in for their MOUD…who are then screened and we find out they have hep[atitis] C, and it opens a gateway for getting their hep[atitis] C treated but also establishing some basic primary care. And it definitely goes the other way around. In our primary care clinic, a lot of patients [are] refer[red] to us that were diagnosed with hep[atitis] C by the [emergency department] or wherever else they came from. And [we ask,] “How’d you get hep[atitis] C? Oh, let’s talk about your opioid use disorder. Do you know that we’ve got meds for opioid use disorder?” And they really kind of…integrate treatment to both.

Yes, absolutely. I think as an APP, we may get a little bit more time to spend with these patients.... So when we’re talking about treating their hep[atitis] C, this can be a time that we can also address other primary care issues with these patient populations.

HCV / Hepatitis

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