The infectious disease landscape has been evolving, largely due to advancements in treatment and technology. The CDC estimates that more than 1.2 million Americans are living with HIV. In the hepatitis C virus (HCV), between 130 and 150 million individuals worldwide have chronic HCV, of whom, approximately 700,000 will die each year from HCV-related liver diseases.
 
In part three of a 4-part exclusive interview with Specialty Pharmacy Times, Ron Nahass, MD, MHCM, FACP, FIDSA, discusses the impact of antiretrovirals and new blockbuster HCV drugs, challenges in the field, patient adherence, telehealth, and more.
 
Dr Nahass has been conducting infectious disease medicine for almost 30 years. He has had a long career in clinical research, and education in the area of chronic viral diseases, including HCV, hepatitis B, and HIV. He currently serves on the American Association for the Study of Liver Disease (AASLD) panel HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C.
 
Click here to read part two of this 4-part interview. 
 
SPT: The United States is one of the top contributors to the funding initiatives the Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS. If President Donald Trump calls for cuts, what global impact would it have on the fight against HIV/AIDS?
Dr Nahass: Under George W. Bush, PEPFAR was initiated, and really to his credit, he was able to move that forward with the compassion that he had to fund that. I don’t know enough about it to know if PEPFAR is going to be in jeopardy with the budget––it is not part of the ACA though. But I could envision where some folks might say we don’t want to fund that anymore because of the way the new administration kind of looks at outside activities. I could envision that being a program that might be at risk.
 
SPT: As specialty drugs came to market, did you have any concerns in prescribing them to your patients?
Dr Nahass: I do a lot of clinical research, so most of these drugs are drugs that I had studied prior to their release. I had a fair amount, if not a robust experience in using most of the drugs both for HIV and hep C. It’s part of what I’ve done throughout my career. I’ve studied these drugs before they were released to the public; sometimes not all of them get released. As a result, I developed a level of familiarity and comfort, we didn’t lose a beat. You didn’t get the drugs unless you were in a study, and we were putting people on the study and getting experience with the drug. As soon as the drug became released, we just started prescribing it for everybody.
 
SPT: In the past, treatment options for patients with HCV were slim and the drugs that were available had harsh adverse events. As new drugs have been released, there are a lot more options. Have you run into any issues with having too many options?
Dr Nahass: No, I think it’s made it better. The more options, the better for patients; the more options, the more competition; the more options, the better the price. So, I think it’s actually been great, it’s been fantastic.
 
SPT: In a study published in the Archives of Sexual Behavior, investigators found a rise in condomless sex among men who have sex with men, suggesting that access to these revolutionary antiretroviral therapies has caused complacency when practicing safe sex. Do you think this could be a possibility?
Dr Nahass: Yes, I think those are good observations, not only with hepatitis C, but if you were to look up syphilis for example, you would also see the syphilis problem in men who have sex with men. The syphilis problem has really been skyrocketing. In New Jersey, I see [cases] at least once, if not twice a month. I think our success in treating HIV has emboldened people to not be so safe in their personal relationships, and consequently we’re seeing hep C and syphilis at levels we haven’t seen before. We’re also seeing chlamydia and gonorrhea at levels we haven’t seen in a long time. So yeah, I think that that’s in fact true.
 
SPT: Mobile health has begun emerging on the health care scene with the hopes of reducing costs and increasing patient engagement. Do you believe telehealth would improve or worsen patient care for infectious diseases?
Dr Nahass: There is an interesting project called the Echo Project, a lot of people have cited it and talked about it. It started in New Mexico, and it’s a telehealth project to get care for HIV and hepatitis C out into very rural areas in Mexico. They’re able to provide expert care for HIV and hep C in those regions of the country that have less dense populations and less dense expert clinicians, and it has worked really well.
 
I see telehealth as making infectious disease experts more widely available in more rural areas. In highly populated, very dense areas of the country, I’m not sure I see it as a particular help––it may be at some point. But I think there’s clear evidence that you can use telehealth to really expand your reach, and leverage your specialty in a way to make meaningful change in population health in the rural areas.