Antiviral Therapies in the Management of Chronic Hepatitis C: The Present and the Future

Antiviral Therapies in the Management of Chronic Hepatitis C: The Present and the Future
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Accreditation | Agenda | Faculty | Registration

 

Locations:

 

Target Audience

Liver disease specialists, hepatologists, gastroenterologists, nurse practitioners who work with specialist/gastroenterology practices and/or treat patients with HCV infection, physician assistants who work with specialist/gastroenterology practices and/or treat patients with HCV infection and nurses who work with specialist/gastroenterology practices and/or treat patients with HCV infection

 

Program Overview/Needs

Hepatitis C is an infection of the liver that can lead to cirrhosis and hepatocellular carcinoma and ultimately result in end-stage liver disease and death. HCV infects 180 million people worldwide and estimates range from 2.7 to 4.1 million in the US.[i],[ii] End-stage liver disease from HCV is the leading indication for liver transplant and is approaching alcoholic liver disease as a leading cause of liver-related death.[i],[ii] Chronic HCV infection has a variable course but usually includes symptom-free years before patients develop cirrhosis, liver failure, and hepatocellular carcinoma.

Beyond its clinical impact and its major impact on patients’ quality of life, HCV carries significant economic consequences. Between 1994 and 2001, health care utilization for HCV-related care increased annually by 25% to 35%[iii]; recent data by Davis et al[iv] demonstrate that the direct economic burden of chronic HCV in the U.S. is a three-fold greater increase in health care costs as compared to non-chronically infected populations.

Over the past 15 years, HCV treatment has improved significantly. The development of PegINF alfa, used in combination with ribavirin as an antiviral therapy, has resulted in decreased mortality, morbidity, potential spread of the virus, and overall burden on the healthcare system.[v] However many HCV-infected individuals who should receive antiviral treatment do not.[i]  Research also shows that many patients with HCV do not receive all recommended care.  Few are receiving vaccination to protect against co-infection with hepatitis A and B[vi],[vii] and few patients with HCV cirrhosis are screened for hepatocellular carcinoma.[viii]   One of the obstacles to HCV treatment is a lack of information among healthcare providers.[i]

The introduction of direct acting oral agents (protease inhibitors) has again transformed the HCV treatment landscape. With these advances in therapy, practitioners’ increased understanding of new treatment options  can have a significant effect on patient health outcomes.[x]  Unfortunately, these dramatic gains in treatment are also offset by new challenges with viral resistance and increased side effects, and clinicians continue to have a steep learning curve to understand and incorporate all factors into their practice. In addition, the rapid pace of HCV research promises new therapies that do not require the use of interferon.  These therapies, which may be available in the next 2-3 years, will have greater efficacy, a shorter duration of therapy, and a much improved side effect profile.  Thus, it becomes ever more important for practitioners to decide whether patients require immediate treatment or may defer therapy until these new agents become available.

[i] Ghany MG, Strader DB, Thomas DL, Seeff LB. Diagnosis, Management, and Treatment of Hepatitis C:
An Update. Hepatology 2009;49:1335-74.
[ii] Colvin H, Mitchell AE. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C. Washington DC: Institute of Medicine, 2010.
[iii] Grant WC, Jhaveri RR, McHutchison JG, Schulman KA, Kauf TL. Trends in health care resource use for hepatitis C virus infection in the United States. Hepatology 2005;42:1406-13.
[iv] Davis KL, Mitra D, Medjedovic J, Beam C, Rustgi V. Direct Economic Burden of Chronic Hepatitis C Virus in a United States Managed Care Population. Journal of Clinical Gastroenterology 2011;45:E17-E24.
[v] Kim WR. The Burden of Hepatitis C in the United States. Hepatology. 2002;36(5 suppl 1):S30-S34.
[vi] Kanwal F, Schnitzler MS, Bacon BR, Hoang TY, Buchanan PM, Asch SM. Quality of Care in Patients With Chronic Hepatitis C Virus Infection A Cohort Study. Annals of Internal Medicine 2010;153:231-U49.
[vii] Kramer JR, Kanwal F, Richardson P et al. Importance of Patient, Provider, and Facility Predictors of Hepatitis C Virus Treatment in Veterans: A National Study. Am J Gastroenterol 2011;106:483-91.
[viii] Davila, JA, Henderson L, Kramer JR et al. Utilization of Surveillance for Hepatocellular Carcinoma Among Hepatitis C Virus-Infected Veterans in the United States. Ann Intern Med 2011;154:85-93.
[x] Michaels AJ, Nelson DR. New Therapies in the Management of Hepatitis C Virus. Current Opinion in Gastroenterology 2010;26:196-201.

 

Educational Objectives

At the conclusion of this activity, participants will be able to:

  1. Decide when in the course of treatment patients will likely benefit from the use of DAA therapy
  2. List both the benefits and the risks of the existing and new therapeutic agents
  3. Describe the goals of treatment for patients diagnosed with chronic HCV and co-morbid conditions such as HIV
  4. Recall which strategies are recommended for the management of treatment-related adverse events
  5. Recount the characteristics of patients for whom HCV treatment is generally accepted and those for whom the decision must be individualized or is contraindicated

 

Accreditation

Boston University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Boston University School of Medicine designates this live activity for a maximum of 2 AMA PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The Continuing Nursing Education Provider Unit, Boston University School of Medicine is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Contact hours: 2

In order to receive credit, nurses should attend the session and complete an evaluation form.

This activity has been developed with consideration given to the American Board of Medical Specialties Six Sore Competencies.

This activity will increase your competency in the areas of:

  • Medical knowledge
  • Practice-based learning and improvement
  • Interpersonal and communication skills
  • Systems-based practice