Hepatitis C Practice Pearls: Screening High-Risk Populations
Hepatitis C virus (HCV) can lead to long-term health problems and even to death. In a Pharmacy Times Practice Pearls series, a panel of experts discussed new, curative treatment options and the restrictions to access. The panel also provided an overview of misinformation, a thorough understanding of the guidelines of HCV, and discussed the various restrictions in access to treatment.
The panel included Christian B. Ramers, MD, MPH, AAHIVS, associate clinical professor at the University of California San Diego School of Medicine and an infectious disease specialist at Family Health Centers of San Diego in San Diego, California; Caroline Derrick, PharmD, BCPS, an assistant professor and infectious diseases pharmacist at the University of South Carolina School of Medicine in Columbia, South Carolina; Chris Hulstein, PharmD, BCPS, a clinical pharmacy specialist at the University of Colorado Hospital in Aurora, Colorado; and Bhavesh Shah, RPh, BCOP, the senior director of specialty pharmacy Boston Medical Center in Boston, Massachusetts.
The panel discussed an overlap between substance use disorder and HCV, which presents an important area for screening high-risk populations.
“Education with screening is important because not everyone wears a sign that says, ‘I'm high risk. Screen me now.’ A lot of times it's a discussion, getting them to open up, and then appropriately screen patients,” Derrick said. “Now everyone should be screened, so it's not just high-risk or this person or that person. We really need to kind of come together, screen everyone, and try to appropriately treat everyone. Because the treatment is good and the SVR [sustained virologic response] rates are high, so we can do that now.”
In terms of populations who need repeat screening on an annual basis, Derrick said those at risk include intravenous (IV) drug users, patients with HIV, and men who have sex with men are groups who should be screened regularly due to their risk to be re-exposed during the year.
For high-risk patients who use drugs but are cured after treatment for HCV, Derrick said their risk of exposure should determine whether they are rescreened annually.
“If they're treated and cured and they're still partaking in high-risk activities, then we should be rescreening them,” she said. “Because being treated and cured and gaining that antibody that they have, does not necessarily mean, as we said earlier, that they're not at risk for reinfection. They can be reinfected, and we need to monitor for relapse as well. There are a lot of other things that come into that. Rescreening would be important.”
Prior recommendations for HCV screening were specific to the baby boomer population and patients in at-risk populations, including those who had ever been on long-term hemodialysis, IV drug users, patients who snort illicit drugs, men who have sex with men, and patients who have been incarcerated. However, the panel noted a paradigm shift in the epidemiology to screening essentially all patients aged 18 years or older at least once during their lifetime.
“What we’re starting to see with the opioid epidemic is that there’s now a huge shift in where hepatitis C hits. It’s largely in a much younger population, even in rural areas. I believe it’s mostly Caucasian, young adults who are using in rural areas,” Hulstein said. “In my practice I’ve seen a number of younger patients who have been exposed to the virus as well through that particular paradigm, so a lot of the focus is starting to get away from the complicated screening risk factors and just doing a little more universal screening overall.”