Hepatitis C Practice Pearls: Risk Factors, Testing

Hepatitis C virus (HCV) can lead to long-term health problems and even to death. In a Pharmacy Times Practice Pearls series, a panel of experts discussed new, curative treatment options and the restrictions to access. The panel also provided an overview of misinformation, a thorough understanding of the guidelines of HCV, and discussed the various restrictions in access to treatment.

The panel included Christian B. Ramers, MD, MPH, AAHIVS, associate clinical professor at the University of California San Diego School of Medicine and an infectious disease specialist at Family Health Centers of San Diego in San Diego, California; Caroline Derrick, PharmD, BCPS, an assistant professor and infectious diseases pharmacist at the University of South Carolina School of Medicine in Columbia, South Carolina; Chris Hulstein, PharmD, BCPS, a clinical pharmacy specialist at the University of Colorado Hospital in Aurora, Colorado; and Bhavesh Shah, RPh, BCOP, the senior director of specialty pharmacy Boston Medical Center in Boston, Massachusetts.

HCV is a viral infection that affects an estimated 3.5 million people in the United States.

“Some of the risk factors for the viral infection itself again are related to blood exposure and screening for those patients or any patients with IV [intravenous] drug use, illicit drug use from a nasal perspective, and incarcerated patients,” Hulstein said. “The screening criteria that are a little bit dated largely focused on the baby boomer population as well for a number of reasons.”

In terms of risk factors for HCV, Hulstein noted that it can be difficult to narrow that down for certain patients.

“For some patients it’s very clear what their exposure had been, but many patients who have presented to clinic may not be aware that they have had the virus and don’t know how they got it. It easily could have been that they had received blood product prior to the 1990s,” he said. “There are coagulation factors in the 1980s as well that were infected. They may have shared a needle or a razor with somebody way back in the day, and it’s just not a very clear picture exactly how they may have gotten it.”

For HCV testing, Shah said that at the institutional level, testing is as simple as sending a blood test to a lab. However, in the community setting, there are different ways of getting testing done.

“There is a quick test you can do—a blood test or a quick that we’ve heard of, which takes about 20 minutes—but you still need a confirmatory blood test that you send out to the lab before getting viral load, genotyping, all that stuff,” Shah said. “I think there’s still complexity in getting the diagnosis of hepatitis C, so it’s not something that’s widely utilized by every single provider.”

Although HCV is now curable, Derrick noted there are varying factors that must be considered prior to starting treatment.

“Before you start someone on treatment, you really need to differentiate between acute and chronic infection,” she said. “We define acute infection as an infection that occurs less than 6 months from diagnosis, so when you have that surface antigen, if you wait 6 months and the surface antigen and viral load are present, that would be defined as a chronic infection. A chronic infection is what we historically have been treating, and there are some nuances of when you may want to treat an acute infection, but chronic infection rate typically uses the definition of an infection after 6 months.”