The High Cost of Hepatitis C Infection

Approximately 3.4 million people in the United States have chronic hepatitis C virus (HCV) infection and it is more prevalent than HIV infection. An estimated 50% of those infected with HCV are not even aware of it, 1 in 3 are aware of their infection but untreated, and only 1 in 6 are referred to specialist care for treatment.

The infection becomes chronic in approximately 75% to 85% of cases and 10% to 20% of infected individuals will develop cirrhosis over a period of 20 to 30 years.¹ The death toll caused by HCV infection increases each year, compared with other infections but the good news is that HCV can be cured with treatment.

The key to the cure is early detection and early treatment. This type of approach is associated with fewer deaths and end stage liver outcomes. With the liver affecting so many other organs, such as the kidneys, eyes, pancreas, and heart, it becomes a crucial organ to stay healthy and away from acute and chronic infections, such as HCV.

This disease is transmitted primarily through parenteral exposures to infectious blood or body fluids that contain blood. The virus can live on the surfaces of a non-injectable drug apparatus.²

One-time, routine HCV testing is recommended for all individuals aged 18 years and older. Persons at risk would include intravenous drug users, hemodialysis patients, children born to HCV-infected women, health care workers after needlesticks, sharps or mucosal exposures, persons receiving tattoos from unregulated settings and those who already have other infections such as HIV and sexually active diseases.

Per current guidelines from American Liver Disease Association, treatment is recommended for all patients with chronic HCV infection and they should be linked to a practitioner who is prepared to provide complete care toward cure. The recommendations are also extended to provide more education to avoid transmission, alcohol abstinence, signs and symptoms, as well as vaccination in general.

Those diagnosed, should get the cure as soon as possible. Prior to starting the therapy, AASLD/IDSA recommends for lab testing, HCV genotype testing and assess for other infections present.³

The 2 most common, recommended, and simplified treatments for HCV are glecaprevir/pibrentasvir (Mavyret) and sofosbuvir/velpatasvir (Epclusa). With Mavyret. the dose would be 300/120 mg to be taken with food for a duration of 8 weeks. With Epclusa, it would be 400/100 mg to be taken for a duration of 12 weeks.

The recommendation should also extend to medication reconciliation by a pharmacist, informing patients with comorbidities, such as diabetes, about hypoglycemia symptoms with these drugs, informing patients taking warfarin for anticoagulation changes, continuous lab monitoring, and physician visit and support programs.

Post treatment would include an assessment for cure, liver disease status, follow up for virologic cure achieved or not. “Cure” simply means sustained virologic response 12 weeks after treatment in infected patients.⁴

Although HCV is a major burden on our society and health care system, both clinically and financially, we know so much about the virus, its diagnosis, and the available treatment and care recommendations that are available.

The key is for health care professionals to comb through these patients, recommend lab testing for those at risk, early detection and treatment with the simple drug options that are recommended, and reduce the spread of this costly disease in society.

Saro Arakelians, PharmD, is vice president of Pharmacy Operations at Mini Pharmacy.

References

• Messina JP, et al. Hepatology 2015;61:77‒87; 2. Yehia BR, et al. PLoS One 2014;9:e101554; 3. CDC. Hepatitis C FAQs for Health Professionals. https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm. Accessed March 2019; 4. Thein HH, et al. Hepatology 2008;48:418—31; 5. Westbrook RH, Dusheiko G. J Hepatol 2014;61:S58–68; 6. AASLD and IDSA. HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C. www.hcvguidelines.org. Accessed March 2019
• AASLD and IDSA. HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C. www.hcvguidelines.org. Updated November 6, 2019. Accessed December 2019; 2. CDC. Hepatitis C FAQs for Health Professionals. https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm. Accessed March 2019; 3. CDC. Factsheet: Hepatitis C & Injection Drug Use. https://www.cdc.gov/hepatitis/hcv/pdfs/factsheet-PWUD.pdf. Accessed March 2019.
• https://www.aasld.org/publications/practice-guidelines
• HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C. www.hcvguidelines.org accessed November 2019.