Federal government releases updated viral hepatitis action plan

"Perhaps the goal with the greatest potential impact relates to increasing awareness of HCV infection," said Dr. Sean Koppe. He noted that less than half of patients with HCV know they are infected, and patients who are unaware of their infections may not learn they have progressive liver disease until they develop symptoms of cirrhosis.

"From the HCV standpoint, I think the action plan is a step, albeit a step that should have been taken several years ago, given that we are currently in the midst of the tremendous burden of HCV cirrhosis and hepatocellular carcinoma," Dr. Koppe said.

Dr. Sean W. Koppe

With expanded health coverage under the Affordable Care Act, increasing awareness of HCV infection to more than 66% is achievable by 2020, he said. "I think that the CDC [Centers for Disease Control and Prevention] and U.S. Preventive Services Task Force recommendation to screen for HCV in those born between 1945 and 1965 will have a significant impact on increasing awareness of HCV infection. Primary care providers are generally well aware of USPSTF recommendations and are implementing these in their practices. We’ve already experienced an increase of newly diagnosed HCV patients in our hepatology clinics that have been diagnosed because of HCV screening by their primary care provider."

The advent of highly effective and tolerable interferon-free regimens for HCV may have some impact on the goals, said Dr. Koppe. But "in addition to increasing awareness of HCV, governmental agencies also need to ensure access to treatment," he said.

"With the recently approved sofosbuvir and its retail price of $1,000 per pill, we are experiencing some challenges with getting some patients access to this highly effective and expensive medication. Because of budget limitations at the VA [Department of Veteran Affairs], we must be highly selective in how we use this medication, and the Department of Veteran Affairs cannot currently afford to treat all of the hepatitis C patients under their care unless Congress increases its budget."

The hepatitis B goals also are relevant, Dr. Koppe said. "It seems one of the biggest barriers to preventing vertical transmission is identifying pregnant women with hepatitis B early enough in pregnancy to allow for antiviral treatment if they are significantly viremic," he said. "In these patients, the use of hepatitis B immunoglobulin and vaccination of the newborn is typically not adequate to prevent transmission."

Dr. Koppe is a gastroenterologist with the Northwestern University Feinberg School of Medicine and the Jesse Brown VA Medical Center, Chicago. His remarks were excerpted from an interview with Frontline Medical News.