Laird Harrison

October 02, 2017

CHICAGO — Barriers to care will be front and center at the upcoming International Conference on Viral Hepatitis (ICVH) 2017.

"We have drugs that can cure hepatitis C in 8 to 12 weeks, but we don't have means to test all populations at risk for hepatitis C, and we don't have access to drugs in many states," said Kenneth Sherman, MD, PhD, from the University of Cincinnati.

Studies on alerts in medical health records to improve screening, point-of-care testing, systematic linkage to care, and special populations — such as patients in prison and patients coinfected with HIV and hepatitis C — will be presented. And epidemiologists will discuss efforts to establish better statistics on the prevalence of infection and new statistical models for eradication.

"Most of the places that hepatitis C concentrates are difficult to penetrate, so you have to find novel ways to integrate screening in these communities," said Nancy Reau, MD, from Rush University Medical Center in Chicago, who is cochair of the conference.

"Screening doesn't do anything if you don't have access to a center that is able to provide treatment," she told Medscape Medical News.

An initiative that offers rapid hepatitis C antibody screening and counseling at the municipal courthouse, a syringe access program, a methadone clinic, and pharmacies in New Orleans will be described. When a test is reactive, the patient is referred to a navigation specialist who sets up RNA testing and subsequent appointments.

Screening doesn't do anything if you don't have access to a center that is able to provide treatment.

And a screening program operating in a detention center, with follow-up assistance for transportation, health insurance, and appointments, will be presented by researchers from the University of North Carolina at Chapel Hill.

For patients undergoing blood tests, a pop-up alert in electronic medical records that reminds providers to screen patients whose hepatitis C status is not documented and who were born between 1945 and 1965 will be described by researchers from the Ruth M. Rothstein CORE Center in Chicago.

A similar program — an alert based on current testing recommendations of the Centers for Disease Control and Prevention — that gives providers a one-click option to order HIV testing, hepatitis C testing, or both will be presented by researchers from West Virginia University in Morgantown.

Caring for Patients With Coinfection

Presentations on the combination of HIV and hepatitis C infection will run throughout the meeting. Because antiretroviral therapy now spares people with HIV from many other deadly infections, chronic liver disease is becoming an increasingly common cause of death, said Edward Cachay, MD, from the University of California, San Diego, who will address this topic during the meeting.

"As these patients are getting older, nonalcoholic fatty disease is becoming more prevalent," Dr Cachay told Medscape Medical News.

The outcomes of direct-acting antiviral drugs on real-world patients with coinfection will be reported by researchers from Kings College Hospital in London. And factors associated with mortality in coinfected patients will be discussed by researchers from the Chicago Department of Public Health.

The care of New Yorkers coinfected with HIV and hepatitis C will be discussed by researchers from the New York City Department of Health and Mental Hygiene. Efforts to eliminate hepatitis C in people with HIV in the Atlanta Veteran's Affairs Medical Center will also be presented.

"Most of the coinfection studies are looking at the integration of screening into high-risk populations, or linkage to care, with a little bit on reinfection rates," Dr Reau explained. "Most of them are on access to therapy."

But the meeting will not deal exclusively with hepatitis C; there will also be presentations on hepatitis B and D. And Dr Sherman will talk about hepatitis E virus, which he believes too many physicians overlook.

"Here in the United States, hepatitis E is a common yet unrecognized, often not considered, virus that can cause acute and, in some cases, chronic hepatitis," he told Medscape Medical News. "The latter often leads to the misdiagnosis of patients with more severe manifestations of disease."

ICVH 2017 is sponsored by the International Association of Providers of AIDS Care (IAPAC), in partnership with the Alliance to Eliminate HIV/HCV Coinfection (AEH2C) and Rush University.

It is in no way affiliated with European meetings also billed as the International Conference on Viral Hepatitis and using the ICVH abbreviation, said Jonathon Hess from IAPAC. Those meetings are sponsored by the World Academy of Science, Engineering and Technology (WASET). WASET has been accused of organizing "predatory" meetings with the goal of collecting registration fees, not advancing science. WASET did not respond to requests for comment.

IAPAC and its cosponsors have not trademarked the name of their meeting. "The other ICVH is always held in Europe and ours is always in the United States, so we figured that was enough of a distinction to avoid confusion," Hess explained.

Dr Sherman, Dr Cachay, and Mr Hess have disclosed no relevant financial relationships. Dr Reau reports relationships with AbbVie, Gilead, Merck, Bristol-Myers Squibb, Boehringer Ingelheim, and Janssen.

Follow Medscape Gastroenterology on Twitter @MedscapeGastro and Laird Harrison @LairdH


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: