Best Practices for the Management of Hepatitis C - Episode 2
Overview and Risk Factors of Hepatitis C
Christopher Hulstein, PharmD, BCPS, provides an overview of hepatitis C, including some risk factors.
CHRISTIAN B. RAMERS, MD, MPH, AAHIVS: Welcome to our program today. Hepatitis C is a viral infection an estimated 3.5 million people in the United States. The landscape of HCV [hepatitis C virus] treatment has evolved over the past decade significantly. Our panel of experts from around the country will provide a better understanding of the common misconceptions behind hepatitis C and the barriers to care for patients. They will share their best practices for the treatment and management of hepatitis C.
I’m Christian Ramers, an 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.
I am joined by Caroline Derrick, an assistant professor and infectious diseases pharmacist at the University of South Carolina School of Medicine in Columbia, South Carolina; Dr Chris Hulstein, a clinical pharmacy specialist at the University of Colorado Hospital in Aurora, Colorado; and Bhavesh Shah, the senior director of specialty pharmacy Boston Medical Center in Boston, Massachusetts.
Thank you for joining us. We’re going to talk about hepatitis C throughout this discussion, talking about misperceptions and the treatments that are available, as well as barriers to access. Before we jump in, let’s start with a general overview of hepatitis C in terms of the transmission, risk factors, the prevalence around the country, and what percentage of patients we think are still undiagnosed. Chris, do you want to start?
CHRISTOPHER HULSTEIN, PHARMD, BCPS: Hepatitis C is a bloodborne viral pathogen. Typically, when we think about transmission, it’s related to risky behaviors around blood. Currently the prevalence is around 3.5 million, depending where you’re looking within that data, but we do think that data are largely underrepresented. Maybe about 50% or so of patients are left undiagnosed from hepatitis C.
Some of the risk factors for the viral infection itself again are related to blood exposure and screening for those patients or any patients with IV [intravenous] drug use, illicit drug use from a nasal perspective, and incarcerated patients. The screening criteria that are a little bit dated largely focused on the baby boomer population as well for a number of reasons.
In large part, it comes from the NHANES [The National Health and Nutrition Examination Survey] database and recommended screening for patients who are born between the years of 1945 and 1965. Unfortunately, the way that was conducted was largely underrepresenting patient populations like the homeless, IV drug users, and those who are incarcerated. Those very high-risk populations were very underreported and really need to be included as part of that screening.
CHRISTIAN B. RAMERS, MD, MPH, AAHIVS: In your clinical practice, do all your patients identify a single risk factor that put them at risk for hepatitis C?
CHRISTOPHER HULSTEIN, PharmD, BCPS: It can be difficult to narrow that down for certain patients. For some patients it’s very clear what their exposure had been, but many patients who have presented to clinic may not be aware that they have had the virus and don’t know how they got it. It easily could have been that they had received blood product prior to the 1990s. There are coagulation factors in the 1980s as well that were infected. They may have shared a needle or a razor with somebody way back in the day, and it’s just not a very clear picture exactly how they may have gotten it.
CHRISTIAN B. RAMERS, MD, MPH, AAHIVS: Possibly related to that 50% undiagnosed rate.