The Hepatitis C Elimination Goal

Transcript

Anthony Martinez, MD: Hello and welcome to this HCPLive® Peer Exchange program titled, Curing Your Patients from Hepatitis C: Addressing Complex Needs with Simplified Treatment Approaches. I’m Dr Tony Martinez, associate professor of medicine at the Jacobs School of Medicine [and Biomedical Sciences] at the University of Buffalo and the medical director of hepatology at Erie County Medical Center in Buffalo, New York. Joining me for today’s discussion are 4 of my colleagues. Would you each please introduce yourselves.

Tipu V. Khan, MD: [Hello], Tony, I’m Tipu Khan. I’m 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’m an adjunct clinical professor at USC [University of Southern California] Keck School of Medicine.

Anthony Martinez, MD: Excellent, welcome.… Nancy?

Nancy Reau, MD: Thank you, Tony. It’s so nice to be here. I’m a transplant hepatologist at Rush University Medical Center in Chicago, Illinois, where I’m also chief of hepatology.

Anthony Martinez, MD: Excellent. Welcome. Mark?

Mark Sulkowski, MD: Hi, Tony. I’m Mark Sulkowski. I’m at Johns Hopkins [University School of Medicine] in Baltimore, where I serve as the medical director of our Viral Hepatitis Center, and a professor of medicine there.

Anthony Martinez, MD: Excellent. Jordan?

Jordan Mayberry, PA-C: [Hello], Tony. Thanks for having me. I’m Jordan Mayberry. I’m a physician assistant at UT [University of Texas] Southwestern [Medical Center] in Dallas in the digestive and liver disease clinic.

Anthony Martinez, MD: Fantastic. Welcome. Our discussion today will focus on screening, diagnosis, and treatment of hepatitis C in various clinical settings, including addiction medicine and primary care. We’ll discuss simple treatment regimens and some strategies on how to incorporate HCV [hepatitis C virus] care into your clinical practice. Welcome, everyone. Let’s get started. The World Health Organization [WHO] has a goal to eliminate hepatitis C by the year 2030. Mark, where do we stand in terms of elimination? Are we on track?

Mark Sulkowski, MD: Well that’s a great question and it’s a good time to ask that. We’re about 7 years away from 2030 and where are we? Back in 2015, WHO said we want to reduce hepatitis C as a public health threat. We’ve got these great medications. We can do it. They set 2 targets. One was reduce mortality by 65%. The other was reduce incidence, that is new cases, by 90%. Where do we stand? Well, if we focus just on the United States, there [are] some good things. With the treatment of older individuals with more advanced liver disease, we have reduced mortality, and in many senses, achieved that particular goal. Not in every subgroup. In fact, the most recent [data] out from the CDC suggest that certain groups of Americans, particularly African Americans, are still dying at a rate that’s far above the other groups. The other place we’re getting an F grade is on incidence. We still have too many new individuals getting infected with hepatitis C across the full spectrum of ages; not just young people, all the way into people over 60 are getting hepatitis C and that’s linked, of course, to injection drug use.

Anthony Martinez, MD: When does it appear that we’re on target to eliminate, if we do get there?

Mark Sulkowski, MD: Well it’s sort of an affinity curve at the current rate with new cases…perhaps matching the number of people cured with treatment. We’re probably at best treading water.

Anthony Martinez, MD: So, Tipu, we’ve just heard that maybe we’re not on track here and we’ve got therapies that are highly effective, safe, relatively easy to use, [and that] really [have become] simple. What do you see [as] some of the barriers prohibiting us from getting to elimination?

Tipu V. Khan, MD: Yes, it’s interesting. I think when we think about barriers, we’re breaking them down to a few categories. The first category is patient. It’s hard to identify these patients. We aren’t doing a great job at screening. Universal screening guidelines are out there. But if we don’t screen them, we’re not going to find them, right? We’re not going to be able to link them to care. So we need to make sure we’re screening people appropriately. Everyone 18 [years] or older should be screened at least once and then more often if they’ve got ongoing risk factors [such as] injection drug abuse. I think what we’ll find when we do that is we’re catching these patients more often.

The other thing I think we run into a barrier with––especially with, as Mark was saying, the incidents being in younger drug-using patients right now––[is] we’re finding that they’re otherwise healthy and they don’t engage in health care, and they don’t come to the doctor because they don’t have a lot of other stuff going on. So I think we need to, as a system, understand that whenever we capture them in the health care system, that could be at a medication-assisted treatment program or screening for incarceration,…we should be able to identify them, screen them, and link them to care. But I think the next step beyond that then, of course, is on our level as prescribing providers. We need to realize that there are simplified algorithms that are out there. Treating hep[atitis] C nowadays isn’t what it was 15 years ago. And it really now has become a primary care disease. And we, as primary care physicians, as addiction specialists, should be the leaders in treating this disease now. I always tell my colleagues that there’s not a lot we do in primary care that’s sexy, right? We are in it for the long haul. But this is one of the few diseases that we can actually cure. We can say, “I’ve got to [get a] cure for you. I’m going to shake your hand and get you cured and we’ll be done with this.” So I think we, as providers, as prescribing providers, need to step up to the plate in screening and then understanding that algorithms are really simple for treatment, which we’ll cover today.

I think the other big barrier is systemic. Over the years, we’ve noticed that there were a lot of barriers for patients to jump through to get treatment. We have to prove sobriety. We have to prove a certain level of liver damage already [and] adherence to treatment. Are there other medical comorbidities that make this patient a higher risk to be treated? And more and more states have [got] rid of those, right?…In a lot of states now, you don’t need a specialist to prescribe. You don’t need comorbidities. If you [have] hep[atitis] C, you should get cured. 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.

Transcript was AI-generated and edited for clarity.