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 correlation between hepatitis C and hepatocellular cancer.
• Outline the impact of new direct-acting antiviral treatment on the development of hepatocellular cancer.

Speaker

Paul Kwo, MD

Dr. Kwo is currently a Professor of Medicine and Director of Hepatology at Stanford University where he joined the faculty in November 2016. Prior to joining the faculty at Stanford, he was at Indiana University for 21 years where he served as the Medical Director of Liver Transplantation. He has distinguished himself in the field of Hepatitis C therapeutics and has been the principal investigator in multiple international trials. He recently authored the ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries.

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,” as there are 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). Prior to 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 now 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.