Hepatitis C: Screening, Identification, and Care

Digestive Disease Week (DDW) 2015

Nancy S. Reau, MD; Lauri R. Graham


July 21, 2015

In This Article

Ongoing Challenges

Medscape: Despite the excitement over a "cure" for hepatitis C, what challenges remain in treating patients?

Dr Reau: Screening and patient education are going to be the two hurdles that we consistently come up against.

The demographics of hepatitis C are changing. In addition to the birth cohort, we recognize that there are still new infections in those who engage in high-risk behaviors. We need to screen the appropriate patients, and when they screen positive, we need to follow up with them. It's like the saying "You can lead a horse to water, but you can't make him drink." You can offer patients education, but they may not be ready for therapy. Still, we have to at least provide them with the understanding that this is a disease that could be fatal or could increase their risk for other diseases. We also need to make sure that they understand that hepatitis C is curable and that they can be linked to a provider to get cured—and even if they're not cured today, that provider can ensure access to therapy when it is appropriate.

One of the other big challenges in such a restrictive environment is that patients only hear that they can't be treated until they have cirrhosis, and that is not the right message. Granted, there is prioritization in treatment now, but the hope is that this means that once the majority of the patients with advanced disease have been cured, prioritization becomes less restrictive.

All of the models for disease eradication show that the sickest patients are treated in the first year, followed by F3 patients in the next year and then F2, to the point that within a few years, F0 and F1—or all patients with HCV—are being treated. So, if you can only treat X number of patients every year, eventually you're going to have eliminated so many cirrhotic patients that the criteria have to become more liberalized.

This is what the patient needs to hear; they need to hear that their insurance isn't going to pay for the drug right now, and not that insurance isn't going to pay until they become cirrhotic. It needs to be explained that insurance companies only have so much money to treat patients, and currently it's those patients with the most advanced disease, but that next year there might be more money to treat less severe disease and we will ask then.

I think the reassurance we can give patients—that they will be treated and that we will help them get that treatment—is very important.


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