Opinion
Video
The Future and Resources in HCV Care
Author(s):
Expert hepatologists discuss future developments in HCV that they are excited about and provide resources for new providers to get started on delivering HCV care.
Transcript
Anthony Martinez, MD: Mark, are you looking into the future? Are you excited about anything in whether treatment of hep[atitis][hepatitis] C or management of hep[atitis][hepatitis] C? Is there anything down the line that's got you excited?
Mark Sulkowski, MD: Certainly, it's a very exciting time. I mean, we've got opportunity in front of us to really for the first time eliminate hep[atitis][hepatitis] C's[in] public health. We can't lose sight of that. I think it's easy to lose sight of that as we struggle with some of the barriers that we've talked about today. So, what do we need to do? Some of you've heard here, we need to increase access to medications. And although tThese medications are highly cost effective, if not [a form of] cost savings, in a relatively short period of time, meaning society will spend less money over a brief period, say five 5 years, if we treat everyone. Despite that, there's there are still barriers to accessing medication. So, tThe first thing we're excited about is removing those barriers. Nancy mentioned and prior authorization forms. I'm working on one now that's 37 patient pages long. Six months we've been back and forth. I'll leave that where it is because there’s not much more I can say. But [the important point is] ensuring we have access. And tThen to pick up on people'sTipu’s point, it's bringing the medications to the patient. And tThere we really need point-of-care testing. So, the second thing I'm excited about is point-of-care PCR [polymerase chain reaction] testing, or antigen testing is another possibility. We mentioned the antibody shows that your immune system has seen hep[atitis][hepatitis] C, but when you cure someone, they remain antibody-positive. So, it [the testing] becomes less effective as we cure more people.. So gGo into a community,[and do] a point-of-care test, a rapid result that shows they're actively affected. Then you've got access. So, yYou reach into the backpack, pull out the medication, hand them a medication, follow that minimal mileage to actually get their phone number, although I'll make another plug for using social media like WhatsApp because they can lose their phone, but they’ll still have the same access. So tThat's the second thing, is point of care. And you say, well, what about people with bad livers? Well, bBring a mobile elastography or fiber scan machine. And iIf your their score is low, you they don't have liver failure. So, point of care. The third thing I'm excited about is actually the potential to develop long-acting therapies. And iIn the HIV space that I've alluded to a couple of times, they now have medications that can be given at that last eight 8weeks. Huh, eight 8 weeks. Well, iIf we had a hep[atitis][hepatitis] C medication that sustained in the liver for eight 8 weeks after a single injection, that would be a one-shot cure. And tThat is being worked on as we speak., Sso, it's not without the realm of possibility. And give me one more.: It's vaccine. And wWe've talked a lot about trying to treat our way out of the hep[atitis][hepatitis] C epidemic, but this is an incredibly transmissible pathogen. We saw that with healthcare–worker needle sticks. We see that with populations and networks of people who inject drugs,. [It’s]incredibly transmissible. So yYes, we should be treating everybody and taking the path of treatment prevention, but vaccine is essential. And tThere's now a lot of excitement around vaccine development and what's called human challenge studies. That's where you take a volunteer with the appropriate informed consent, you intentionally give them hepatitis C, and vaccinate some and see if the vaccine can clear the infection. And then oOf course, you've got treatment to rescuethem,…those who don't clear. It sounds a bit crazy, but they do this with malaria, they do this with dengue, they do this with shigella, diarrhea, and they did this with COVID-19, intentionally affecting [infecting] people. And wWhy would you do that? Because it allows you to test vaccine candidates very quickly. If they don't work, move on. So tThose are the things I'm excited about as we work our way to 2030. It's only seven 7years away, so we've got a lot of work to do.
Anthony Martinez, MD: So sSome exciting things [are] on the horizon potentially. For some of our viewers who might not be aware, iIt's really an exciting time around Hep[atitis][hepatitis] C. We have a relatively newly announced federal elimination plan that has been brought forward. This is something that's obviously very fluid and dynamic, but it's in development. . [There are] [It has] the three 3 key components,: iIt would fast track point-of-care tests like Mark has described. It would open access to medications, hopefully eliminating a lot of the barriers that we've discussed. And it would also provide funding for the infrastructure needed to actually carry this work out. So sStay tuned for all of this, there is a lot that'’s happening. We'’ve covered a lot of ground. Nancy, if providers, if viewers [patients] are looking for more information, do you have any go-to sites that they can access to get more infoit?
Nancy Reau, MD:Well, aAbsolutely. There are tons of them. So I think that Hep[atitis][Hepatitis] CP Live actually has great tools, the American Liver Foundation, [and] you cannot go wrong with things like the CDC or the World Health Organization. Also, I wouldn't discount your industry partners, especially once you [patients] know the agent that you're[they’re] being started on. There are really great resources on those websites when [they] you know what you're[they’re] going to be taking. But I think that misinformation is also prevalent. So yYou want to make sure that you're talking to your patients about what their fears are. There still are websites out there that say that Hep[atitis][hepatitis] C treatment is intolerable, that you're going to end up with depression or some of the interferon-related side [adverse] effects, [or] that you won't be able to work through things, or that these are still experimental. I mean, tThese are not experimental therapies anymore. And so, yYou want to make sure that you're using a tool that's vetted and up-to -date, not archaic.
Anthony Martinez, MD: YeahYes, hcv.com is also another great resource.— A alot of information there, practical information about implementation, and tons of great educational content. Thanks to all of you for this rich and informative discussion. And thank you, our viewers, for joining us during this HCP Live Peer Exchange. If you enjoyed today's content, please subscribe to our e-news letters to receive information regarding upcoming peer exchanges and other great content right to your inbox. Thank you very much.
Transcript was AI-generated and edited for clarity.
