Tatyana Kushner, MD, MSCE: HCV Screening, Treatment, and Elimination

In an interview with HCPLive during The Liver Meeting 2023 from the American Association for the Study of Liver Diseases (AASLD) in Boston this weekend, Tatyana Kushner, MD, MSCE, associate professor of medicine in the division of liver diseases at the Icahn School of Medicine at Mount Sinai, discussed the White House hepatitis C elimination plan, clinicians’ role in addressing this issue, and disparities in patients affected by HCV.

“The goal is to have a national plan to work towards hepatitis C elimination, and within that proposed plan, there are specific aspects to address,” Kushner explained.

Components of the goal include providing easier access to medications, improving the process from testing to treatment, and emphasizing the need for research, especially as it pertains to the development of a hepatitis C vaccine. Beyond those elements, Kushner also described the role clinicians must play in eliminating HCV and emphasized the need for screening.

“If you're seeing a patient, whether it's in primary care or any other healthcare setting, you need to screen them for hepatitis C. And that is really, really important. Even if you're not someone who sees many hepatitis C patients, it is an important part of your healthcare maintenance that you need to screen,” Kushner said.

The difficulty in addressing the growing prevalence of HCV lies in clinicians’ inability to treat difficult populations. Kushner explained that easy-to-treat populations aren’t a problem, but more attention and resources must be diverted to communities that are considered challenging to treat, including “people who are living with homelessness, people who are injecting drugs, people who are not regularly accessing the healthcare system.” In addition to paying special attention to challenging populations, Kushner also emphasized the importance of “the whole cascade of care,” spanning from initial screening through treatment and follow-up visits.

“There are just inherent disparities in terms of access to health care, and we need to really work hard to make sure that in addition to disparities, we make sure that stigma is addressed and people are feeling comfortable enough to access healthcare. If you're in a setting where there's a lot of stigma, and they're not even comfortable with being in healthcare, then it will be impossible to address hepatitis C in this population,” Kushner explained.

Looking at HCV from a sex-based perspective, women who inject drugs are at a greater risk of HCV than men for reasons Kushner described as “multifactorial,” including participating in higher-risk injection behaviors, greater frequency of injection, and stigmas surrounding pursuing harm reduction services. Screening and treatment during pregnancy may offer new opportunities for engaging female patients in care they otherwise would not seek.

“Pregnancy is a time when women are coming to you, they are engaged in care, and they're already getting all this testing, so it's our chance to screen them and also make sure they're linked to treatment. The question of treatment during pregnancy is still being looked at. There's actually data at this meeting which shows that treatment in the second and third trimester is looking promising,” Kushner said. “Clearly there's an important interaction with having liver disease and pregnancy and pregnancy outcomes, so I do think that it's really becoming part of what we're doing, and I think the first-ever guidance that we have is kind of a testament to that.”