Published October 11, 2019
New draft recommendations for hepatitis C virus (HCV) that recommend screening for adults ages 18 to 79 are exactly what are needed to address the dramatic increase in incidence of the infection, according to HCV expert Andrew H. Talal, MD.
The recommendations further state that clinicians may want to consider screening pregnant people younger than age 18.
Talal, a professor of medicine in the Division of Gastroenterology, Hepatology and Nutrition, notes that the new guidelines are a critical step toward fully addressing the HCV epidemic.
“The keys to eliminating HCV are boosting screening, increasing awareness among clinicians and patients, and finally, linking those diagnosed to care,” he says.
“We now have all the tools needed to eliminate this deadly infection. The new recommendations are an extremely important step on that road.”
“These draft recommendations are a tremendous step forward in addressing the grim realities that we have been seeing over the past several years with HCV,” says Talal, who is a physician with UBMD Internal Medicine, where he directs a liver diseases specialty practice.
Previously, ongoing HCV screening was recommended only for individuals at high risk, and one-time HCV screening was recommended for baby boomers without ongoing potential viral exposures — specifically for those born between 1945 and 1965.
“Currently, a third of all people who use drugs between the ages of 18 and 30 years are infected with HCV,” notes Talal.
“Between 2006 and 2014, HCV incidence doubled among women ages 15 to 44, and from 2011 to 2014, there were 68 percent more infants born to HCV-infected mothers.”
The draft recommendations were issued Aug. 27 by the U.S. Preventive Services Task Force (USPSTF), an independent, volunteer panel of national experts in disease prevention that works to improve the health of Americans by making evidence-based recommendations about clinical preventive services.
In response to the increased incidence of HCV infection locally, Talal and his colleagues in the Jacobs School of Medicine and Biomedical Sciences and Kaleida Health recently initiated a rigorous screening program at four emergency departments at Kaleida Health hospitals, one of the Jacobs School’s clinical training sites and health care partners.
The program provides screening for all individuals ages 13 to 73 who come to the emergency department for any reason; it goes beyond the USPSTF recommendations to initiate screening at age 18.
The screening program is possible through an award from the Gilead Sciences Inc. Frontlines of Communities in the United States program.
Once a diagnosis is made and patients are linked to care, treatment results in a more than 95 percent cure rate after 8-12 weeks of treatment in most individuals, with minimal serious adverse events.
“Viral elimination is associated with decreased mortality, both from liver diseases and other causes, and from cirrhosis and hepatocellular carcinoma,” Talal explains. “This has encouraged many state governments, as well as the federal government, to set the elimination of HCV as a worthwhile and feasible goal.”
Talal, a member of Gov. Andrew M. Cuomo’s New York State Hepatitis C Elimination Task Force, is principal investigator on a $7 million Patient-Centered Outcomes Research Institute award to study how innovations, such as telemedicine and partnering with opioid treatment programs, can effectively address HCV in people with substance use disorders.
HCV is a casualty of the national opioid epidemic: A majority of those who have it are substance users who share needles or preparation equipment, many of whom are not aware that they are infected.
The purpose of the research is to find more effective ways to treat these individuals who are at very high risk of developing HCV, but are especially difficult to treat in conventional health care settings. The integration of “virtual management” of HCV treatment with opioid treatment through telemedicine is seen as a way to reach and treat this vulnerable population.
“We are also able to distribute the HCV medications simultaneously with methadone as a method to increase medication adherence,” explains Talal.
So far, seven opioid treatment programs comprising a total of 12 sites, all members of the Coalition of Medication-Assisted Treatment Providers and Advocates of New York State (COMPA), are participating in the UB study, which integrates treating substance abuse with HCV treatment.
COMPA leaders have noted they are proud to be involved in the study and are hopeful that, if proven successful with HCV, telemedicine might be a useful approach to treating other diseases where their patients face similar challenges.