Q&A: Viral hepatitis awareness grows through patient, physician efforts

Viral hepatitis refers to several types of inflammatory liver infections that can lead to serious complications like fibrosis or cirrhosis. While some types of hepatitis may be prevented with vaccination and others can clear spontaneously, many patients remain unaware of the risks for infection or their current infection status.

Nancy S. Reau

In honor of Hepatitis Awareness Month and Hepatitis Testing Day on May 19th, HCV Next spoke with Nancy S. Reau, MD, from Rush University Medical Center and a member of the American Liver Foundation’s National Medical Advisory Committee, about the state of viral hepatitis awareness and the challenges that remain between screening and linkage to care.

HCV Next : Do you think physician awareness and education regarding viral hepatitis and available testing options has improved in recent years?

Reau: There has been considerable effort placed on physician and patient awareness. This has led to better disease recognition in physicians but screening in our at-risk populations still lags.

HCV Next : How has testing for viral hepatitis — particularly, hepatitis A, hepatitis B and hepatitis C — improved in recent years?

Reau: Outlining the risk in the birth cohort from 1945 to 1965 has improved identifying HCV testing, especially in combination with electronic medical records where patients in need of screening can be electronically flagged. Outside of the birth cohort, patients need to be identified by risk. Individuals will need to be asked questions about risk behavior, country of birth, risk in parents, to appropriately identify those in need of HBV and HCV screening. Failure to find these individuals leads to continued disease progression and preventable disease transmission. All patients with viral hepatitis should be considered for vaccination against hepatitis A and B.

HCV Next : W hat are the barriers to increasing hepatitis testing in primary care settings? What is needed to overcome these barriers?

Reau: Asking risk-based questions remains a challenge. Primary care is already tasked with so many responsibilities it’s hard to slow down a patient visit with uncomfortable questions. Although currently not advocated, universal screening would allow easy patient identification naturally facilitated by our EMR.

HCV Next : If a patient tests positive for viral hepatitis, how can physicians ensure the patient is linked to care?

Reau: The best way to link a patient is to make sure the patient understands that the disease is serious, and therapy can help them; may even cure them. Patients are strong advocates and are more willing to navigate the complex care cascade if they believe it is important. Also, understanding which local specialists have an interest in viral hepatitis can be highly beneficial. That prevents a referral that simply results in another referral to a hepatitis provider. – by Talitha Bennett