New HCV Guidance: Rapid Updates for Clinicians

Laura A. Stokowski, RN, MS, Helen W. Boucher, MD; Paul Martin, MD

Disclosures

March 21, 2014

In This Article

Medscape Talks to Paul Martin, MD, and Helen W. Boucher, MD, for Perspectives on New HCV Guidance

Medscape recently spoke with Dr. Paul Martin, a hepatologist and member of the guidance writing panel, and Dr. Helen W. Boucher, an infectious diseases specialist, about the new HCV guidance, including key points of emphasis about the content of the guidance, the implications for clinical practice, and what clinicians can expect in the way of updates.

Medscape: HCV treatment is still in flux -- it almost seems impossible to settle on treatment guidelines. How did the HCV guidance first come about?

Dr. Boucher: The HCV guidance was sponsored by the IDSA and the AASLD, with IAS-USA as the collaborating partner. The 2 societies have decided that the best way forward with the treatment of hepatitis C infection is to collaborate, and I think what is so exciting about this new guidance is the partnership behind it. We have recognized the need to provide up-to-date information, and that is what our societies have done with this guidance. The speed with which the guidance document was achieved was extremely noteworthy.

Medscape: You refer to the HCV guidance as a "living document." How does this differ from the model that we are accustomed to in medicine?

Dr. Martin: The whole area of hepatitis C treatment is evolving so rapidly that we felt that it was crucial that treating healthcare providers have access to up-to-date information. The more traditional practice guidelines go through a detailed process and take some time to appear in print. Clearly, however, this whole field is moving so rapidly that we felt that it was best to have our recommendations online as soon as possible. As far as updating it, the same panel will be involved, and additional experts may be invited to participate for specific topics. The idea is that this will be updated on a regular basis. We plan to add additional sections later on. Clearly, however, the HCV guidance reflects treatment options in the United States, as these new drugs may not yet be licensed in other countries where different standards of care exist.

I think this is probably going to be the wave of the future, because we are all now so dependent on the Internet for information. We use the Internet in the office to research clinical questions when a patient is being seen, and I think practice guidelines in the future will reflect what we have done and mirror this sort of model. Speed and completeness are going to be the watchwords of the future.

Medscape: Is it significant that the document is called "HCV Guidance" rather than "HCV Guidelines"?

Dr. Martin: Yes. We view it that guidelines are typically developed after a protracted process, and the word "guidance" reflects the need to make recommendations available to potential treaters in a relatively short period. The recommendations are still based on a combination of review of the literature and consensus of expert opinion, but we view guidance as reflecting an up-to-date process.

Dr. Boucher: We were (and still are) experiencing an explosion of information about how best to treat patients with HCV, similar to what happened with HIV years ago The IAS-USA has done something similar, in a very high-quality way, for HIV/AIDS.

Medscape: With the recommendation to test all "baby boomers" (people born between 1945 and 1965) in addition to risk-based screening, the numbers of individuals with active hepatitis C infection are going to climb in the near future, and concerns have been raised about having enough healthcare providers to evaluate and treat all of these individuals.

In the section on testing and linkage to care, it says, "All patients with current HCV infection and a positive HCV RNA test result should be evaluated by a practitioner with expertise in assessment of liver disease severity and HCV treatment." Does this mean that primary care/internal medicine practitioners should refer all newly diagnosed patients to liver specialists?

Dr. Martin: We didn't restrict management of HCV to any particular discipline. The key thing is in managing hepatitis C is that although you are managing a viral disease, you are also managing the liver disease. We didn't seek to preclude any type of healthcare practitioner from caring for these patients, but we wanted to recommend that patients be seen by somebody who can not only treat the viral infection but also understands that the severity of the liver disease needs to be addressed -- because ultimately that is going to determine, or be an important component of determining, the patient's prognosis.

Dr. Boucher: The important point is that the patient ends up with a healthcare practitioner who is expert in managing his or her disease. Many physicians are expert in treating HCV. Some are infectious diseases trained, and some are gastroenterology/hepatology trained. It differs by medical center; there are no absolutes.

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