Patient Education and Treatment Strategies Implemented at a Pharmacist-Managed Hepatitis C Virus Clinic

Bonnie Kolor, Pharm.D.


Pharmacotherapy. 2005;25(9):1230-1241. 

In This Article

Abstract and Introduction

Hepatitis C virus (HCV) infection is a major public health concern. Approximately 4 million people in the United States have been infected with the virus, and up to 85% of them will develop chronic infection. Chronic HCV infection has often been associated with progression of hepatic fibrosis and, in some cases, cirrhosis and end-stage liver disease. The standard of care is combination therapy with pegylated interferon (peginterferon) alfa plus ribavirin. More than 50% of patients with HCV treated with combination therapy achieve a sustained viral response, defined as undetectable hepatitis C viral RNA 6 months after the end of therapy. Effective patient education and drug therapy management are critical in enabling patients to adhere to the treatment regimen, which is either 24 or 48 weeks long, depending on the virus strain. The drug regimen is associated with several possible adverse events as well as weekly subcutaneous administration (of peginterferon alfa). Frequent monitoring of patients and, often, adjustments in the dosage of one or both components of the therapy are necessary during the treatment course. Strategies used by clinical pharmacists at an HCV clinic are discussed that can facilitate a successful treatment outcome for patients with HCV treated with combination therapy, while enabling them to maintain a reasonable quality of life.

Hepatitis C virus (HCV) infection is a worldwide health problem affecting approximately 170 million people.[1] In the United States, it has been estimated that almost 2.7 million individuals are chronically infected with the virus.[2] In the United States, the prevalence of HCV infection is generally believed to be higher among veterans served by Veterans Affairs (VA) hospitals than in the general population. An estimated 5.4% of veterans who receive care through the VA medical centers are likely to have been infected with HCV, whereas the overall estimated prevalence of HCV exposure in the United States is only 1.8%.[2,3]

Hepatitis C is of particular clinical significance because up to 85% of infected patients may develop chronic infection (HCV viremia persisting for more than 6 mo after initial HCV infection).[4,5,6,7] Chronic HCV infection has been associated with serious clinical sequelae, such as development of hepatic fibrosis, cirrhosis of the liver, and hepatocellular carcinoma. Although the natural history of HCV infection is considered highly variable, it has been estimated that up to 20% of patients with chronic HCV infection develop cirrhosis over a 20-25-year period.[6,7,8] These patients are at increased risk for developing end-stage liver disease and/or hepatocellular carcinoma.

Furthermore, chronic HCV infection is the leading reason for liver transplantation in the United States.[1] In some patients, HCV infection has also been associated with extrahepatic complications, such as cryoglobulinemia and certain autoimmune disorders.[6,9,10] In addition, evidence suggests that infection with HCV may increase the risk of developing type 2 diabetes mellitus. The number of new cases of HCV infection/year in the United States is thought to be declining.[11,12] However, it has been predicted that HCV-associated morbidity and mortality will increase substantially in the near future due to the often prolonged period between infection and clinical disease.


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