HCV Consults: Volume 1, Number 3

Curing HCV

Issue: July 2015

One of the most gratifying experiences in the nontransplant portion of our hepatology practices is to cure patients with hepatitis C (HCV). With the advent late last year of the new direct-acting antiviral agents, the joy and fulfillment of informing patients that they have triumphed over their longstanding viral scourge occurs several times per week or even daily. The contrast with the past resides not only in the increasing frequency with which cure can be achieved, but in the relative painlessness and brevity of therapy involved. This professional pleasure will likely intensify in the upcoming months.

Patients cured of HCV often articulate their profound relief as, “I feel like I have my life back,” and they frequently report improvement in quality of life as a lifting of “brain fog” or feeling much more energized. These observations, which undoubtedly have biologic foundations that remain to be fully elucidated, are sometimes expressed as early as the 4-week visit on interferon-free therapy, leading to an irresistible temptation to ascribe subjective improvement to viral suppression without the overlying effects of interferon confounding the picture.

These observations suggest that the ramifications of HCV are more far reaching than the threat posed by progressive liver disease. The emotional burdens of infection, including the knowledge that one might transmit the virus to loved ones, can be profound. Patients typically experience quality-of-life detriments rooted in part in the emotional repercussions of HCV, but also in the altered biologic milieu indigenous to chronic infection, with upregulated expression of multiple chemokines, cytokines, and so on. Finally, several important extrahepatic diseases associated with HCV infection have been documented, including diabetes; B-cell proliferative disorders, such as cryoglobulinemia and lymphoma; and most recently, atherosclerosis.

The potential ramifications of HCV infection make this virus eminently worthy of eradication even in patients whose livers are not affected by advanced fibrosis at the time of diagnosis. In this context, limiting the new curative, interferon-free therapies only to those who have advanced fibrosis (when the risk of liver cancer has already materialized and cannot be reversed completely, even with virologic cure) would be most unfortunate. How great the irony if we were free in the past to administer interferon for protracted durations with lower rates of efficacy but could not treat the same patient in the future with highly effective, well-tolerated regimens of shorter duration. Our collective goal should be providing access to the new treatments for all clinicians and patients who are medically eligible for them.

Click here to see Education Lab Activity.

Learning Objectives:

At the conclusion of this activity, participants should be able to:

Implement new regimens for HCV by evaluating evidence-based clinical data on the safety and efficacy of new HCV treatment regimens to assist in clinical decision making.
Evaluate the use of interferon-based versus interferon-free regimens for the treatment of HCV.

Overview

Author(s)/Faculty: Ira M. Jacobson, MD; Norman Gitlin, MD, FRCP, FRCPE, FACP, FACG; Paul Y. Kwo, MD; Jean-Michel Pawlotsky, MD, PhD; Paul I. Pockros, MD
Source: Healio Infectious Disease Education Lab
Type: Monograph
Articles/Items: 8
Release Date: 8/31/2014
Expiration Date: 8/30/2015
Credit Type: CME
Number of Credits: 1.5
Cost: Free
Provider: Vindico

CME Information

Provider Statement: This continuing medical education activity is provided by Vindico.
Support Statement: This activity is supported by educational grants from AbbVie and Genentech Inc.
Target Audience: The intended audience for this activity is gastroenterologists, hepatologists, infectious disease specialists, nurse practitioners, physician assistants and other health care professionals involved in the treatment of patients with hepatitis C virus (HCV).