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AASLD Online HCV Guide Update Includes Key At-risk Populations
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The American Association for the Study of Liver Diseases and the Infectious Diseases Society of America recently updated their hepatitis guideline website, HCVguidelines.org, to include several new testing and management recommendations for pregnant women, men who have sex with men, people who inject drugs and incarcerated individuals.
Kristen M. Marks, MD, assistant professor of medicine at Weill Cornell Medical College in New York and HCV Guidance co-chair, discussed the new updates with Healio Gastroenterology and Liver Disease.
According to Marks, the guideline is a combined effort between AASLD and IDSA to help not only hepatology, gastroenterology and infectious disease specialists in treating and managing HCV, but to provide information to all health care providers.
“It’s a document for really anyone who is interested in hepatitis C and we are trying to reach a wider audience,” Marks said. “The website has really been effective with thousands of hits each month.”
Healio: What are the new recommendations?
Marks: With each release, we update from what we had, either adding or subtracting information. In this case, all that we did was add to the document. The biggest change was adding universal screening for women. This was added because, with the opioid epidemic, we’re seeing greater incidence rates in younger people, so we recommend screening women because they are in that age group. There are essential benefits to them during their pregnancy of knowing their hepatitis C status in terms of care that can be provided to them as well as having the opportunity to test the infant after its born.
In the past, it was recommended to do risk-based screening and testing for hepatitis C in pregnant women — like the general population — but we know from HIV that risk-based screening doesn’t adequately detect infection in people, so we recommend opt-out testing. We already test pregnant women for HIV and hepatitis B, so it’s logical to add hepatitis C at that point.
Healio: What has been updated for men who have sex with men, people who inject drugs and people in correctional institutes?
Marks: These populations were sort of covered with the general guidance information, but we carved out special sections because they’re such important populations in terms of ending the epidemic.
There’s a lot of emphasis now on the ability to actually eliminate hepatitis C. And that’s a weird word to use, eliminate really means to stop the spread, stop new cases of hepatitis C from occurring; so, to prevent new infections is really the definition of elimination. We can do that by treating groups who are the most likely to have hepatitis C.
Unfortunately, in the current era, these may be people who are denied treatment because of certain policies that limit access to hepatitis C medication. We wanted to draw special emphasis to the groups that we know are key populations in the fight to end the hepatitis C epidemic.
Each of these sections in the guide — men who have sex with men, people who inject drugs and people in correctional institutions — will provide background on why these groups are so important; specific guidance on how often to test, who to test, and how to test in terms of not only checking for the antibody but to do the reflex RNA testing in all of these settings; and remind physicians to test people who may be at risk of reinfection after treatment.
Healio: What does the website provide for physicians?
Marks: The website is logically organized with drop-down menus, so people can quickly find the information they’re looking for.
One section is ‘Test, Evaluate, Monitor,’ two of them have to do with treatment, and the newer one is focused on unique and key populations, which includes topics that were always available on the website, like coinfection and decompensation cirrhosis, but has had pregnancy, children and the other key populations we talked about added in. These sections will take you directly to the topic in the document, which is also printable with the current release’s date.
Healio: What is important for physicians to keep in mind regarding HCV?
Marks: Now is a time we can cure nearly everyone with hepatitis C, so we recommend treatment for everyone. We’re trying to help people understand what populations may have been previously neglected who may require urgent priority and provide recommendations on how to go about testing, managing and treating these patients.
This is the optimal time to test for and treat hepatitis C because we have such good treatment. We know that we can help prevent further transmission and hopefully work toward these goals that the WHO and other groups have of eliminating hepatitis C.
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Disclosure: Marks reports no relevant financial disclosures.