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Revolutionary drug regimens are now available (and more are on the horizon) that have the potential to cure hepatitis C virus (HCV) infection in many patients. With chronic HCV infection affecting approximately 3.2 million individuals in the United States, and about 17,000 cases being identified each year, the urgency for detection of the disease and delivery of treatment is evident.1,2 Since most cases of HCV infection are asymptomatic, it is crucial for healthcare providers to be informed of who is at increased risk, and of the promising new drugs for counteracting the disease.
Until severe liver damage occurs, many infected individuals remain asymptomatic for years, so screenings are vital for persons at risk. Those with potential exposure to the virus are at the highest risk, including persons who: received clotting factor concentrates made before 1987, or received blood transfusions or solid organ transplants before July 1992; are current or former injection drug users, including those who injected only once or at any time in the past; are on chronic hemodialysis; have had known exposure to HCV, such as those who are recipients of blood or organs from a donor who tested HCV-positive; are HIV positive; or who were born to HCV-positive mothers.1
Determination must be made as to whether an HCV infection is acute or chronic. Since it is not possible to determine a specific viral cause of the illness based on signs, symptoms, history, or current risk factors, specific serologic testing must be conducted.1 The CDC provides laboratory criteria for diagnosis, categorized by Hepatitis C, acute and Hepatitis C, past or present, and it also provides online guidelines for laboratory testing and result reporting. The likelihood is that approximately 75%–85% of HCV infections become chronic. When this occurs, the condition can lead to debilitating outcomes, or even fatalities. For example, approximately 60–70 individuals out of 100 end up developing chronic liver disease, and 1–5 will die from the consequences of chronic infection (liver cancer or cirrhosis).1
While HCV vaccine is unavailable, effective treatment options exist, including groundbreaking new types of pharmacotherapy. Standard treatment has involved combination therapy with interferons (such as PegIntron, Pegasys, Infergen, Intron A) and ribavirin (such as Copegus, Rebetol, Ribasphere). The related success rates have recently been improved with the addition of polymerase and protease inhibitors to standard pegylated interferon/ribavirin combination therapy. Breakthrough treatments now available that have the potential to dramatically improve the incidence of HCV infection include Olysio (a protease inhibitor) and Sovaldi (a polymerase inhibitor), both which received FDA approval in the last quarter of 2013. In addition to receiving pharmacotherapy, patients with HCV infection should be educated about topics that are relevant to their condition, such as informing them about the low but present risk for transmission through unprotected sex, and that they should not donate blood, organs, tissue, or semen, as this can spread HCV. It is also important to caution patients about consuming substances that can harm the liver or accelerate liver disease.
PDR Network is a valuable resource for information on thousands of available products, including those used to treat HCV, offering alerts and specific product labeling. Keep current by using PDR.net and by keeping your contact information up to date with us. If you use an electronic health record (EHR), please ask for it to include the PDR drug data feeds, including PDR BRIEF, which delivers updated drug information, full labeling, and safety warnings integrated into your electronic prescribing system automatically, and at NO cost to you. Drug information in EHRs is often months out of date, which is why PDR BRIEF is available at no cost to providers and EHR vendors.
PDR Network can also help you meet certain reporting requirements under Meaningful Use Stage 2 (MU2). One of the core MU2 objectives, "use certified EHR technology to identify patient-specific education resources," requires that physicians provide more than 10% of their unique patients with education resources specific to their needs.3 PDR+ for Patients drug education guides are an excellent resource that you can provide patients to help you meet this objective. When PDR+ for Patients drug education guides are integrated into your EHR, you can use them to help you fulfill this objective and help your patients start and stay on therapy. Click here to see a sample. Don’t have PDR+ in your EHR? Email us at EHR@pdr.net to tell us the name of your EHR vendor, and we will convey to them that you want PDR included in your EHR.
Salvatore Volpe, MD, FAAP, FACP, CHCQM
Chief Medical Officer