Target Audience

Providers and clinical staff who are interested in providing treatment and care to individuals diagnosed with Hepatitis C (providers, nursing, behavioral health, linkage navigators, front desk/scheduling, admin, etc.).

Learning Objectives

• Discuss the importance of screening for Hepatitis D Virus (HDV).
• Review the HDV pathophysiology.
• Describe treatment for HDV.

Speaker

Norah Terrault, MD, MPH, FAASLD
Professor of Medicine, Chief, Division of GI and Liver: Neil Kaplowitz Chair in Liver Diseases, Keck School of Medicine of University of Southern California

Dr. Norah Terrault is a Professor of Medicine and Chief of Gastroenterology and LiverDiseases at the Keck School of Medicine at the University of Southern California. She received her MD from the University of Alberta. She completed fellowships in Internal Medicine and Gastroenterology at the University of Toronto and a Masters in Public Health at the University of California at Berkeley.

Dr. Terrault has focused her clinical and research activities on viral hepatitis and non-alcoholic fatty liver disease, especially in special populations including those with cirrhosis and transplants. In addition to multiple clinical trials related to preventing and treating chronic hepatitis viral hepatitis and fatty liver, Dr. Terrault has been PI on multiple NIH-funded studies, including the current NIH-supported HBV clinical research network (HBRN) and nonalcoholic steatohepatitis clinical research network (NASH CRN). She has authored 330 peer-reviewed manuscripts, editorials, invited reviews as well as US national guidelines for the treatment of chronic hepatitis B and C. She is a past associate editor for Hepatology, deputy editor for Liver Transplantation, and co-edited Zakim and Boyer’s textbook in hepatology.

She is the founder of ECHO-Plus, a multifaceted program to train and support primary care physicians in California to care for patients with hepatitis. She has a long history of mentoring fellows and junior faculty in clinical research. She is passionate about creating research support and opportunities for the next generation of GI/Hepatology investigators. Dr. Terrault was recently elected as Councilor to the AASLD governing board and will serve as president in 2023.

Full biography.

Professional Practice Gap - National

Hepatitis C virus (HCV) infection is a blood-borne infectious disease that causes substantial liver-related morbidity and an increased risk of liver cancer and liver-related death. HCV is often known as a “silent disease,” with few noticeable symptoms, especially in early-stage infection. Because of this, many individuals are unaware of their HCV until more serious, late-stage complications arise. Treatment is available for HCV, with success measured by the sustained viral response (SVR) rate at 12 to 24 weeks post-treatment (i.e., no detectable virus). Before 2014, an average of 48 to 70% of people achieved SVR with the available therapies; however, recent advances in therapeutic medications increased SVR rates to more than 95% in 2018. Achieving SVR can reverse the effects of early-stage fibrosis and slow the progression of cirrhosis to decompensation or hepatocellular carcinoma (HCC). This reduces liver-related mortality by 20-fold and all-cause mortality by 4-fold. Transmission of HCV can be prevented by avoiding direct exposure to contaminated blood or blood products, including objects that may have come in contact with contaminated blood, such as syringes and other drug paraphernalia. 

Over the last 14 years, the HCV epidemic has drastically changed in the U.S. Originally a disease affecting “baby boomers” (people born between 1945 and 1965), HCV has reemerged as a syndemic with opioid use and overdoses, methamphetamine use, and HIV. In 2010, approximately 3.5 million Americans were living with chronic HCV. According to CDC data, HCV kills more Americans than any other infectious disease. In addition, HCV is the leading cause of cirrhosis and liver cancer and the most common reason for liver transplantation in the U.S. In 2013, deaths from HCV-related causes surpassed the total combined numbers of deaths from 60 other infectious diseases reported to the CDC, including HIV and tuberculosis. In 2014, HCV-related deaths reached an all-time high with more than 19,600 deaths reported. At the same time, there has been a marked simultaneous increase in the number of people newly diagnosed with HCV across the US, particularly among people with a history of injection drug use. The U.S. experienced marked increases in hospital admissions for acute HCV and for opioid injection between 2004 and 2014, with the number of people newly diagnosed with HCV more than doubling between 2010 and 2014.

National-level programs to control the burden of HCV have focused primarily on the older cohort of people with HCV. These programs include screening for HCV in the baby-boomer cohort (born 1945 to 1965) and programs offered through the Veteran’s Administration (VA) to diagnose and cure all veterans with HCV. Despite these efforts, barriers to treatment still exist at the state Medicaid level, as evidenced in many states by restrictions on treatment, including fibrosis scarring requirements that preclude treatment for people with early-stage liver disease. Universal procedures exist to prevent HCV transmission in medical settings across the U.S. (though localized outbreaks may still occur when procedures fail). However, the recent opioid crisis combined with increased methamphetamine usage in some parts of the country present new challenges for HCV prevention efforts. At present, policies to prevent transmission among drug users are entirely state-specific, and in many states, these policies simply do not exist.

Professional Practice Gap - Iowa

At the beginning of 2017, there were 26,900 Iowans with chronic HCV (HCV RNA+ viremic infections) in Iowa. Approximately 59% of people with chronic HCV were previously diagnosed (n= 15,900), with around 1,500 people being diagnosed annually, and 8% of people with diagnosed HCV (n=2,200) being initiated on treatment annually. There were an estimated 870 people acquiring HCV annually, an incidence rate of 57.8 per 100,000 in 2017. In addition,

• 52% of people with chronic HCV were in the 1945 to 1965 birth cohort*
• 14% of people with chronic HCV were women of child bearing age*
• 4% of people with chronic HCV were people who inject drugs*
• The number of people with chronic HCV in prisons was unknown
• The number of people with chronic HCV in Medicaid was unknown

*Percentages do not sum to 100% because overlap exists across groups and not all subpopulations are considered here.