13
Jun
2014

Hepatitis C Screening

  • The USPSTF reccomends screening for hepatitis C in ALL individuals born between 1945 and 1965
  • (age 49-69) thats a huge chunk of our patient population!
  • It also reccomends screening for individuals regardless of age who are at risk.
  • It is a grade B reccomendation.
  • From rounding on GI and discussing with ID staff there are newer promising antiviral regiments coming out soon.
  • Please view the following  update to see how this will affect us at the VA!!
  • Full hepC USPSTF guideline
  • Hope this was helpful 🙂

 

 

9 Responses

  1. Vamsi Krishna Chilluru

    Its interesting to know that we need to screen patients between 1945 vand 1965 which incldes almost 50-60% of VA population.

  2. Maryam Gbadamosi-Akindele

    Vamsi,
    1)I think the push for all the screening is all the new interferon free regimens that are coming out.
    2)Newer agents called DAA(direct antiretroviral agents) have shown in studies to have 96% SVR (sustained viral response) these include sofosbuvir,ritonavir,dasabuvir,ledipasvir.
    3)Issues with these studies are that they focused on genotype 1, however the other genotypes are very prevalent in the rest of the world. Also the studies were mainly in patients without cirrhosis. In addition another issue will be the cost of these new medications.
    4)Here is a nice review article in NEJM that discusses this topic.

  3. Renuga Vivekanandan

    Hi Everyone
    Lots of exciting things are happening with Hep C. As of Dec 2013 we have 2 new drugs which are Sofosbuvir and Simeprevir. There are many more drugs in the pipe line which may be approved as early as 2015.

    As you know Hep C has 6 Genotype. Genotype 1 and 4 are the most common in US. In the past the treatment entailed greater than 6 months of combination therapy with interferon and ribavirin and the older agent Telaprevir or boceprevir. Unfortunately patient were not able to tolerate the duration of therapy and the side effects came along with these agents.

    With Sofosbuvir and Simeprevir the duration of therapy is only 12 weeks and only genotype 1 and 4 currently require interferon and ribavirin combination therapy. The SVR rates like Maryam mention is well above 95% in most cases.

    There are even more promising drugs in the pipeline which may reduce the duration of therapy to 8 weeks and interferon free.

    We should be screening all our patients and those at highest risk from 1945-1965. If you guys have any questions I’m always available to answer.

  4. Hamza Tantoush

    Thanks Dr. V was nice post. My Q frequent you check the viral load for monitoring or just you will wait for 8-12 week then see the response.

    How about if no response to treatment do you still recheck genotype mutation.

  5. Hamza Tantoush

    I guess we can come up with QI project specially at the VA primary clinic to screen those targeted with the new guild line if Dr. V agree.

  6. Renuga Vivekanandan

    Great question. With the new treatment they don’t even recommend viral load until you are done with treatment. We should have a viral load prior to starting hep c treatment.. However during my treatment of pt— some pts like to know if it’s working and some times I have gotten viral load to show the treatment is working.. I think it will be a great QI project.. Happy to help

  7. Renuga Vivekanandan

    Very little mutation has been reported with new drug.. SVR has been greater than 95%. However if you are going to use simeprevir regimen without sofosbuvir then there is recommendation to check for simeprevir polymorphism for NS3 Q80K at baseline. Pt with this has not very good response to simeprevir. In about 6 months we will have most likely have one pill for 8 week.

So, what do you think?

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