Transmission of HCV in the United States (CDC estimate)

Size: px
Start display at page:

Download "Transmission of HCV in the United States (CDC estimate)"

Transcription

1

2 Transmission of HCV in the United States (CDC estimate)

3

4 Past and Future US Incidence and Prevalence of HCV Infection Decline among IDUs Overall incidence Overall prevalence Infected 20+ years Armstrong GL, et al. Hepatology. 2000;31: Graphic courtesy of the CDC.

5 Often a Silent Disease until its too late Over the last 20 to 30 years, liver disease in many undiagnosed or untreated hepatitis C patients has silently progressed: -In the 1990s, the most common finding on liver biopsy was stage 0 (no liver damage). -Now 20 years later the most common finding will soon be Stage 4 (cirrhosis). 1990s 2015

6 Good news- Less new cases of Hepatitis C over the last 20 years Bad news- many of the millions of people infected in the 1970 s and 1980 s are silently progressing to cirrhosis and liver failure

7

8 Vertex Pharmaceuticals Incorporated, March 2010

9 Does curing Hepatitis C alter the patient s prognosis? YES!!! Curing HCV has many benefits: I. Actual regression (improvement) of the liver scars II. Decreased incidence of liver failure III. Decreased incidence of liver cancer IV. Reduced all-cause mortality V. Improved life expectancy VI. Prevent viral transmission to others

10 How to work up your patient with Hepatitis C You screened your patient, and now the HCV antibody test is positive. What do you do next? 1.To confirm active disease obtain: Virus (HCV), Quantitative, PCR (QuantaSURE ) If HCV RNA is detectable- they have active disease If HCV RNA is not-detectable- the disease has resolvedspontaneously or due to prior successful treatment. either A positive HCV antibody test only means they have been exposed to HCV. About 20 % of patients will spontaneously clear the infection, but their antibody test will remain positive. They do not need treatment!

11 Blood work 1. HCV Genotype over time, HCV has evolved into different strains, referred to as genotypes 1 thru 6. Some HCV drugs may only block viral replication in a specific genotype, while other drugs may work against all genotypes. Genotype 1, the most common genotype in the United States is broken down further into genotype 1a and 1b. It is critical to determine the genotype before prescribing therapy. In the United States: Genotype 1a 55% genotype 3-14% genotype 1b- 15% genotype 4-1% genotype 2 15 %

12 Other blood tests: Chemistry panel and ProTime evaluates liver function albumin, t.bili and ProTime; and inflammation- AST and ALT CBC- thrombocytopenia is a good predictor of cirrhosis Iron panel and ferritin- increased levels could mean hemochromatosis or cirrhosis AFP- elevated levels seen in cirrhosis and liver cancer Hepatitis A antibody, total and Hepatitis B Surface ag and Surface ab- if not immune, good to vaccinate these patients against HAV and/or HBV HIV screen

13 Other tests: Liver /spleen Ultrasound- don t order an abdominal ultrasound, L/S ultrasound is cheaper and it is all you need: write evaluate Hepatitis C this way the radiologist knows to look for signs of cirrhosis, portal hypertension and hepatoma Hepatitis C FibroSURE (A LabCorp test) A blood test that takes a number of lab values and correlates them with stage of liver disease.

14 Stage of Disease-how much damage has occurred to the liver Does your patient have cirrhosis? 1. Need to know if the patient has cirrhosis, since this is when the risk of liver cancer or decompensation increases, and the course of therapy may need to be extended 2. Degree of liver damage is described by Stage, and reflects the amount of scarring to the liver 3. At this time- most insurances only cover therapy if patient has moderate to advanced liver disease

15 Stage of liver disease based on Metavir Scale from 0 to 4- how much scarring (fibrosis) is present in the liver Stage 0- no damage Stage 1 mild scarring Stage 2- moderate scarring Stage 3- advanced disease Stage 4- severe scarring with distortion of the liver structure-this stage is called cirrhosis

16 Options for Liver Fibrosis Assessment Liver biopsy: gold standard Elastography: approved in United States Liver Biopsy Serum markers of fibrosis Serum Biomarkers Axial CT/MRI, US can demonstrate cirrhotic morphology, portal hypertension

17 HCV life cycle and how the new drugs work - Right now there are three important enzymes ( a protease, a polymerase and an enzyme involved in viral replication) which are the targets of the new antiviral drugs. If you can block these enzymes effectively enough- then the virus has no where to hide and the infection resolves. Two or three potent antivirals working together at different sites in the life cycle are enough to cure most patients

18 Treatment : For Genotype 1a or 1b: Two choices : Either a combination of two antiviral drugs Sofosbuvir and Ledipasvir (in one tablet called Harvoni ) Or three antivirals in a BID regimen called Viekira Pak +/- ribavirin For Genotype 2 or 3: Sofosbuvir (Sovaldi ) and ribavirin together 90 to 100% of all patients can be cured with these regimens!

19 Three Hepatitis C treatment terms to know: 1. SVR12- (Sustained Virologic Response, week 12)- this is the accepted definition of cure. It means at 12 weeks after completion of therapy, the HCV remains non-detectable. Very rare to relapse after that time period. 2. Treatment naïve- patient has never been treated before 3. Treatment experienced- the patient has been treated with but not cured previously with dual therapy (interferon and ribavirin) or triple therapy (interferon, ribavirin and a protease inhibitor). These patients may not respond as quickly to the new therapies as a treatment naïve patient, and may therefore require a longer course of medication to achieve SVR12.

20 Case #1-65 year old vet with mild disease Used drugs in the late 1960s in the service, hospitalized with hepatitis. None since No alcohol for 27 years Diagnosed at VA when established care in 2008 Liver biopsy showed Stage 1 fibrosis in 2008 Had some depression, decided against therapy with interferon and ribavirin then Recently saw a TV ad about new HCV meds, decided to come to see if he was a candidate HCV antibody test is positive

21 Case 1, cont PMH- none PE- sharp, palpable liver edge NO palmer erythema or spider angiomata

22 Case 1-Lab results Platelets- 280,000 AST/ALT- 45/73 Albumin 4.2, T. bilirubin 0.9mg/dl INR- nl Fe/TIBC- 34% AFP- 4.2 Genotype 1a HCV viral load- 695, 657 copies/ml HIV- neg, HAV IgG +, HBV Sag-/Sab- APRI score- (45/33)/280 x 100 = 1.1 (mild fibrosis) Ultrasound- mildly enlarged liver, no masses or portal hypertension

23 Questions? In 2008, how did we confirm he has active Hepatitis C? It is an active infection, so what is the utility now of each of the following tests in evaluating your patient? 1. CBC 2. Chemistry panel, PT/INR 3. Fe/TIBC 4. Genotype 5. Ultrasound and AFP 6. HIV, HAV IgG, HBV Sag and Sab Started on Harvoni daily for 8 weeks, so far non-detectable week 4. Cure rate > 95%

24 Case #2-65 year old alcoholic with cirrhosis Used nasal cocaine in the 1970s and 1980s, none for 30 years. No combat, no tattoos, no transfusions Retired, plays golf and has 3 to 4 hard drinks a few times a week with his buddies Diagnosed in 2014 at the VA with HCV No other major medical problems

25 Case #2, cont. PE: tremulous, has rosacea enlarged liver, possible spleen tip palmer erythema distended veins on abdomen

26 Case 2-Lab results Platelets- 94,000 AST/ALT- 48/51 Albumin 3.5 mg, T. bilirubin 0.6mg/dl INR- nl Fe/TIBC- 34% AFP- 9.6 Genotype 1b HCV viral load- 388,800 copies/ml HIV- neg, HAV IgG -, HBV Sag-/Sab- APRI score- (48/33)/94 x 100 = 1.6 (advanced fibrosis) Ultrasound- mildly enlarged, nodular liver, no masses or portal hypertension, c/w cirrhosis (Stage 4)

27 Case #2, cont. Patient told unless he completely stops drinking, will not be offered HCV therapy and likely to die in relatively near future of liver failure Over next 6 months switches to Coors non-alcohol beer after golfing, loses 30 pounds. Appears motivated To start Viekira Pak with ribavirin for 12 weeks this week cure rate > 95%

Review: How to work up your patient with Hepatitis C

Review: How to work up your patient with Hepatitis C Review: How to work up your patient with Hepatitis C You screened your patient, and now the HCV antibody test is positive. What do you do next? The antibody test only means they have been exposed to HCV.

More information

Update on Hepatitis C. Sally Williams MD

Update on Hepatitis C. Sally Williams MD Update on Hepatitis C Sally Williams MD Hep C is Everywhere! Hepatitis C Magnitude of the Infection Probably 8 to 10 million people in the U.S. are infected with Hep C 30,000 new cases are diagnosed annually;

More information

HEPATITIS C THERAPY PRIOR AUTHORIZATION FORM: Page 1 of 3 Patient Information. Diagnosis Acute Hep C Chronic Hep C Hepatocellular Carcinoma

HEPATITIS C THERAPY PRIOR AUTHORIZATION FORM: Page 1 of 3 Patient Information. Diagnosis Acute Hep C Chronic Hep C Hepatocellular Carcinoma HEPATITIS C THERAPY PRIOR AUTHORIZATION FORM: Page 1 of 3 Patient Information Recipient: MA#: Date of Birth: Phone #: Body Weight: Treatment Plan Sovaldi (sofosbuvir) 400mg: Take once daily for weeks Olysio

More information

1.How did I get Hepatitis C?

1.How did I get Hepatitis C? 1.How did I get Hepatitis C? Sharing needles and syringes ( iv drug use ) or using contaminated straws to snort cocaine Reused needles or medications in a health care setting- (LV endoscopy outbreak, glucometers

More information

PRIOR AUTHORIZATION PROTOCOL FOR HEPATITIS C TREATMENT

PRIOR AUTHORIZATION PROTOCOL FOR HEPATITIS C TREATMENT PRIOR AUTHORIZATION PROTOCOL FOR HEPATITIS C TREATMENT HARVONI (90mg ledipasvir/400mg sofosbuvir): tablet (PREFERRED AGENT) SOVALDI (sofosbuvir ): 400mg tablets (PREFERRED AGENT ) OLYSIO (simeprivir) PEG-INTRON

More information

Hepatitis C Treatment Criteria Commercial & Minnesota Health Care Programs

Hepatitis C Treatment Criteria Commercial & Minnesota Health Care Programs Last update: February 23, 2015 Hepatitis C Treatment Criteria Commercial & Minnesota Health Care Programs Please see healthpartners.com for Medicare coverage criteria. Table of Contents 1. Harvoni 2. Sovaldi

More information

New IDSA/AASLD Guidelines for Hepatitis C

New IDSA/AASLD Guidelines for Hepatitis C NORTHWEST AIDS EDUCATION AND TRAINING CENTER New IDSA/AASLD Guidelines for Hepatitis C John Scott, MD, MSc Associate Professor, UW SoM Asst Director, Liver Clinic, Harborview Medical Center Presentation

More information

The following should be current within the past 6 months:

The following should be current within the past 6 months: EVALUATION Baseline Labs Obtain at time or prior to initial evaluation CBC with diff PT/INR CMP HCV Genotype (obtained PRIOR TO consult visit) HCV RNA (obtained PRIOR TO consult visit) Hep A IgG Hep BsAg,

More information

Sovaldi (sofosbuvir) Prior Authorization Criteria

Sovaldi (sofosbuvir) Prior Authorization Criteria INITIAL REVIEW CRITERIA Sovaldi (sofosbuvir) Prior Authorization Criteria 1. Adult patient age 18 years old; AND 2. Prescribed by a hepatologist, gastroenterologist, infectious disease specialist, transplant

More information

Hepatitis Update. HCV Cure As A Paradigm for Convergence of Interests. Evidence Based Nuts and Bolts For the Family Doc 11/5/2014

Hepatitis Update. HCV Cure As A Paradigm for Convergence of Interests. Evidence Based Nuts and Bolts For the Family Doc 11/5/2014 Evidence Based Nuts and Bolts For the Family Doc Hepatitis Update William Carey MD MACG, FAASLD Oct 25, 2014 HCV Cure As A Paradigm for Convergence of Interests Hepatitis C Cure 1 Get Ready Get SET Go

More information

HCV in 2020: Any cases left? Rafael Esteban Hospital General Universitario Valle Hebron Barcelona. Spain

HCV in 2020: Any cases left? Rafael Esteban Hospital General Universitario Valle Hebron Barcelona. Spain HCV in 2020: Any cases left? Rafael Esteban Hospital General Universitario Valle Hebron Barcelona. Spain Yes, still too many Measures to eradicate an Infectious Disease Prevention: Vaccination Screening

More information

Clinical Criteria for Hepatitis C (HCV) Therapy

Clinical Criteria for Hepatitis C (HCV) Therapy Diagnosis Clinical Criteria for Hepatitis C (HCV) Therapy Must have chronic hepatitis C (HCV infection > 6 months), genotype and sub-genotype specified to determine the length of therapy; Liver biopsy

More information

HBV & HCV induced. Liver Cirrhosis Iradj Maleki MD Gut & Liver Research Center Mazandaran University of Medical Sciences

HBV & HCV induced. Liver Cirrhosis Iradj Maleki MD Gut & Liver Research Center Mazandaran University of Medical Sciences HBV & HCV induced Liver Cirrhosis Iradj Maleki MD Gut & Liver Research Center Mazandaran University of Medical Sciences Definition of Cirrhosis Final pathway for a wide variety of chronic liver diseases

More information

Cirrhosis and HCV. Jonathan Israel M.D.

Cirrhosis and HCV. Jonathan Israel M.D. Cirrhosis and HCV Jonathan Israel M.D. Outline Relationship of fibrosis and cirrhosisprevalence and epidemiology. Sequelae of cirrhosis Diagnosis of cirrhosis Effect of cirrhosis on efficacy of treatment

More information

PHARMACY PRIOR AUTHORIZATION

PHARMACY PRIOR AUTHORIZATION PHARMACY PRIOR AUTHORIZATION Hepatitis C Clinical Guideline Harvoni (sofosbuvir/ledipasvir), Sovaldi (sofosbuvir), Viekira PAK (ombitsavir, paritapravir/ritonavir, dasubavir), and Olysio (simeprevir) Authorization

More information

MEDICAL POLICY STATEMENT

MEDICAL POLICY STATEMENT MEDICAL POLICY STATEMENT Original Effective Date Next Annual Review Date Last Review / Revision Date 5/21/2014 3/24/2016 3/24/2015 Policy Name Policy Number Hepatitis C Oral SRx-0003 Medical Policy Statements

More information

Patterns of abnormal LFTs and their differential diagnosis

Patterns of abnormal LFTs and their differential diagnosis Patterns of abnormal LFTs and their differential diagnosis Professor Matthew Cramp South West Liver Unit and Peninsula Schools of Medicine and Dentistry, Plymouth Summary liver function / liver function

More information

Ledipasvir/Sofosbuvir (Harvoni) for Treatment of Hepatitis C

Ledipasvir/Sofosbuvir (Harvoni) for Treatment of Hepatitis C Ledipasvir/Sofosbuvir (Harvoni) for Treatment of Hepatitis C Policy Number: Original Effective Date: MM.04.034 12/1/2014 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 12/1/2014

More information

Albumin. Prothrombin time. Total protein

Albumin. Prothrombin time. Total protein Hepatitis C Fact Sheet February 2016 www.hepatitis.va.gov Laboratory Tests and Hepatitis If you have hepatitis C, your doctor will use laboratory tests to about learn more about your individual hepatitis

More information

Hepatitis C Glossary of Terms

Hepatitis C Glossary of Terms Acute Hepatitis C A short-term illness that usually occurs within the first six months after someone is exposed to the hepatitis C virus (HCV). 1 Antibodies Proteins produced as part of the body s immune

More information

Disclosure of Conflicts of Interest Learner Assurance Statement:

Disclosure of Conflicts of Interest Learner Assurance Statement: Raj Reddy, MD Ruimy Family President's Distinguished Professor of Medicine Professor of Medicine in Surgery Director of Hepatology Director, Viral Hepatitis Center Medical Director, Liver Transplantation

More information

Hepatitis C: Increasing Access and Improving Cure Rates

Hepatitis C: Increasing Access and Improving Cure Rates Hepatitis C: Increasing Access and Improving Cure Rates David Hachey, Pharm.D., AAHIVP Professor Idaho State University Department of Family Medicine 1 Disclosures The planners and presenter have disclosed

More information

HIV and Hepatitis Co-infection. Martin Fisher Brighton and Sussex University Hospitals, UK

HIV and Hepatitis Co-infection. Martin Fisher Brighton and Sussex University Hospitals, UK HIV and Hepatitis Co-infection Martin Fisher Brighton and Sussex University Hospitals, UK Useful References British HIV Association 2010 http://www.bhiva.org/documents/guidelines/hepbc/2010/ hiv_781.pdf

More information

MEDICAL ASSISTANCE HANDBOOK PRIOR AUTHORIZATION OF PHARMACEUTICAL SERVICES. I. Requirements for Prior Authorization of Hepatitis C Agents

MEDICAL ASSISTANCE HANDBOOK PRIOR AUTHORIZATION OF PHARMACEUTICAL SERVICES. I. Requirements for Prior Authorization of Hepatitis C Agents MEDICAL ASSISTANCE HBOOK I. Requirements for Prior Authorization of Hepatitis C Agents A. Prescriptions That Require Prior Authorization Prescriptions for Hepatitis C Agents that meet any of the following

More information

The question and answer session is not available after the live webinar.

The question and answer session is not available after the live webinar. 1 Read verbatim. 2 The Infectious Diseases Society of America (IDSA) Hepatitis C Knowledge Network offers monthly, 1 hour webinars to educate IDSA members on current recommended practices and treatments

More information

PRIOR AUTHORIZATION POLICY

PRIOR AUTHORIZATION POLICY PRIOR AUTHORIZATION POLICY Harvoni (sofosbuvir/ledipasvir tablets Gilead) To initiate a Coverage Review, Call 1-800-417-1764 OVERVIEW Harvoni is a fixed-dose combination of ledipasvir, a hepatitis C virus

More information

Request for Prior Authorization HEPATITIS C TREATMENTS

Request for Prior Authorization HEPATITIS C TREATMENTS IA Medicaid Member ID # Patient name DOB FAX Completed Form To 1 (800) 574-2515 Provider Help Desk 1 (877) 776-1567 Patient address Patient phone Provider NPI Prescriber name Phone Prescriber address Fax

More information

Peg-IFN and ribavirin: what sustained virologic response can be achieved by using HCV genotyping and viral kinetics?

Peg-IFN and ribavirin: what sustained virologic response can be achieved by using HCV genotyping and viral kinetics? Peg-IFN and ribavirin: what sustained virologic response can be achieved by using HCV genotyping and viral kinetics? Prof. I. Bakulin Gastroenterology Department Key Questions Background Worldwide prevalence

More information

Hepatitis C Monitoring and Complications (and Treatment!) Dr Mark Douglas

Hepatitis C Monitoring and Complications (and Treatment!) Dr Mark Douglas Hepatitis C Monitoring and Complications (and Treatment!) Dr Mark Douglas Hepatitis C Virus Shimizu et al., 1996 Positive single strand RNA virus Flaviviridae family, Hepacivirus genus 9.6 kbp genome ~3000

More information

Newly Diagnosed: HEPATITIS C. American Liver Foundation Support Guide

Newly Diagnosed: HEPATITIS C. American Liver Foundation Support Guide Newly Diagnosed: HEPATITIS C American Liver Foundation Support Guide T he American Liver Foundation's mission is to facilitate, advocate, and promote education, support, and research for the prevention,

More information

HEPATITIS C - STATE OF THE ART -

HEPATITIS C - STATE OF THE ART - HEPATITIS C - STATE OF THE ART - Steven J. Ayres, M.D. January 23, 2015 11 th Annual Northcentral Montana Rural Physicians and Advanced Practitioners Conference Disclosures Dr. Ayres has no disclosures

More information

Hepatitis B and C Co-infection. Mark Hull MHSc, FRCPC Clinical Assistant Professor Division of AIDS

Hepatitis B and C Co-infection. Mark Hull MHSc, FRCPC Clinical Assistant Professor Division of AIDS Hepatitis B and C Co-infection Mark Hull MHSc, FRCPC Clinical Assistant Professor Division of AIDS Objectives Review natural history of hepatitis coinfection Brief overview of treatment indications for

More information

Medical Policy An independent licensee of the Blue Cross Blue Shield Association

Medical Policy An independent licensee of the Blue Cross Blue Shield Association Hepatitis C Second Generation Antivirals (2015) Page 1 of 14 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: See also: Hepatitis C Second Generation Antivirals Through

More information

Hepatitis C. Laboratory Tests and Hepatitis C

Hepatitis C. Laboratory Tests and Hepatitis C Hepatitis C Laboratory Tests and Hepatitis C If you have hepatitis C, your doctor will use laboratory tests to check your health. This handout will help you understand what the major tests are and what

More information

HEPATITIS C. The Facts. Get Tested. Get Cured! Health

HEPATITIS C. The Facts. Get Tested. Get Cured! Health HEPATITIS C The Facts Get Tested. Get Cured! Health EVEN IF YOU FEEL HEALTHY, HEPATITIS C MAY BE DAMAGING YOUR LIVER. Your liver keeps you healthy in many ways, such as by removing toxins from your blood

More information

Commonly Asked Questions About Chronic Hepatitis C

Commonly Asked Questions About Chronic Hepatitis C Commonly Asked Questions About Chronic Hepatitis C From the American College of Gastroenterology 1. How common is the hepatitis C virus? The hepatitis C virus is the most common cause of chronic viral

More information

Hepatitis C. Eliot Godofsky, MD University Hepatitis Center Bradenton, FL

Hepatitis C. Eliot Godofsky, MD University Hepatitis Center Bradenton, FL Hepatitis C Eliot Godofsky, MD University Hepatitis Center Bradenton, FL Recent Advances in Hepatitis C Appreciation that many patients are undiagnosed Improved screening to identify infected persons Assessment

More information

Hepatitis C Virus (HCV)

Hepatitis C Virus (HCV) HFS Report to Legislative Task Force Hepatitis C Arvind Goyal MD, MPH, MBA Medical Director Illinois Department of Healthcare and Family Services Hepatitis C Virus (HCV) Slowly progressive disease 40 years-median

More information

Hepatitis C. David Mutimer Queen Elizabeth Hospital Liver Unit Birmingham. Substance Misuse Treatment in the West Midlands. How can we reduce harm?

Hepatitis C. David Mutimer Queen Elizabeth Hospital Liver Unit Birmingham. Substance Misuse Treatment in the West Midlands. How can we reduce harm? Hepatitis C David Mutimer Queen Elizabeth Hospital Liver Unit Birmingham Substance Misuse Treatment in the West Midlands. How can we reduce harm? Birmingham October 19 th 2007 infection HCV Natural History

More information

HCV/HIVCo-infection A case study by. Dominic Côté, Nurse Clinician B.Sc Chronic Viral Illness Services McGill University Health Centre

HCV/HIVCo-infection A case study by. Dominic Côté, Nurse Clinician B.Sc Chronic Viral Illness Services McGill University Health Centre HCV/HIVCo-infection A case study by Dominic Côté, Nurse Clinician B.Sc Chronic Viral Illness Services McGill University Health Centre Objectives By sharing a case study of a patient co-infected with HIV/HCV

More information

HCV Case Study. Optimizing Outcomes with Current Therapies

HCV Case Study. Optimizing Outcomes with Current Therapies HCV Case Study Optimizing Outcomes with Current Therapies This program is supported by educational grants from Kadmon and Merck Pharmaceuticals. Program Disclosure This activity has been planned and implemented

More information

Chronic Hepatitis C Virus (Chronic HCV)

Chronic Hepatitis C Virus (Chronic HCV) Chronic Hepatitis C Virus (Chronic HCV) Amie Baumgartner PA-C Fall 2015 Purpose of Lecture! Educate Gastroenterology nurses about Hepatitis C and its treatment in order to improve their knowledge and confidence

More information

Hepatitis C Second Generation Antivirals (Harvoni, Technivie TM, Viekira Pak ) Prior Authorization - Through Preferred Agent(s) Program Summary

Hepatitis C Second Generation Antivirals (Harvoni, Technivie TM, Viekira Pak ) Prior Authorization - Through Preferred Agent(s) Program Summary Hepatitis C Second Generation Antivirals (Harvoni, Technivie TM, Viekira Pak ) Prior Authorization - Through Preferred Agent(s) Program Summary This program applies to Health Insurance Marketplace, FlexRx

More information

Prior Authorization Conditions for Approval of Hepatitis C Agents

Prior Authorization Conditions for Approval of Hepatitis C Agents Prior Authorization Conditions for Approval of Hepatitis C Agents All requests for Hepatitis C Agents require a prior authorization and will be screened for medical necessity and appropriateness using

More information

Goals of Therapy. Treatment Options for Hepatitis C. Patterns of Response. Progress in Hepatitis C Therapy

Goals of Therapy. Treatment Options for Hepatitis C. Patterns of Response. Progress in Hepatitis C Therapy Treatment Options for Hepatitis C Helen S. Te, M.D. Center for Liver Diseases University of Chicago Hospitals Chicago, Illinois Primary: To eliminate the virus Goals of Therapy Secondary: To decrease inflammation

More information

What to Do with the Patient With Abnormal Liver Enzymes? Nizar N. Zein, M.D. The Cleveland Clinic

What to Do with the Patient With Abnormal Liver Enzymes? Nizar N. Zein, M.D. The Cleveland Clinic What to Do with the Patient With Abnormal Liver Enzymes? Nizar N. Zein, M.D. The Cleveland Clinic Introduction Elevated liver enzymes is often not a clinical problem by itself. However it is a warning

More information

UPDATE ON NEW HEPATITIS C MEDICINES

UPDATE ON NEW HEPATITIS C MEDICINES UPDATE ON NEW HEPATITIS C MEDICINES Diana Sylvestre, MD 2014 AASLD/IDSA Guidelines: Gt 1 Treatment naïve Interferon eligible: sofosuvir + ribavirin + PEG-IFN x 12 weeks Interferon ineligible: sofosbuvir

More information

Beginner's guide to Hepatitis C testing and immunisation against hepatitis A+B in general practice

Beginner's guide to Hepatitis C testing and immunisation against hepatitis A+B in general practice Beginner's guide to Hepatitis C testing and immunisation against hepatitis A+B in general practice Dr Chris Ford GP & SMMGP Clinical Lead Kate Halliday Telford & Wrekin Shared Care Coordinator Aims Discuss:

More information

Clinical Criteria for Hepatitis C (HCV) Therapy

Clinical Criteria for Hepatitis C (HCV) Therapy Diagnosis Clinical Criteria for Hepatitis C (HCV) Therapy Must have chronic hepatitis C, genotype and sub-genotype specified to determine the length of therapy; Liver biopsy or other accepted test demonstrating

More information

Update on hepatitis C: treatment and care and future directions

Update on hepatitis C: treatment and care and future directions Update on hepatitis C: treatment and care and future directions Professor Greg Dore Viral Hepatitis Clinical Research Program, National Centre in HIV Epidemiology and Clinical Research, University of New

More information

A 55 year old man with cirrhosis due to chronic hepatitis C (CHC) genotype 3a is referred for liver transplantation.

A 55 year old man with cirrhosis due to chronic hepatitis C (CHC) genotype 3a is referred for liver transplantation. A 55 year old man with cirrhosis due to chronic hepatitis C (CHC) genotype 3a is referred for liver transplantation. Three years ago he was treated with 24 weeks of peginterferon alfa-2a (180 µg/wk, PEGIFN)

More information

Medical Policy An independent licensee of the Blue Cross Blue Shield Association

Medical Policy An independent licensee of the Blue Cross Blue Shield Association Hepatitis C Second Generation Antivirals Page 1 of 22 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Hepatitis C Second Generation Antivirals Through Preferred

More information

INFORMATION ABOUT HEPATITIS C

INFORMATION ABOUT HEPATITIS C INFORMATION ABOUT HEPATITIS C PATIENT BOOKLET Index 1 About Hepatitis C About Hepatitis C Page 1 Hepatitis C Transmission Page 3 Hepatitis C Disease Progression Page 4 Hepatitis C Diagnosis and Treatment

More information

Surveillance for Hepatocellular Carcinoma

Surveillance for Hepatocellular Carcinoma Surveillance for Hepatocellular Carcinoma Marion G. Peters, MD John V. Carbone, MD, Endowed Chair Professor of Medicine Chief of Hepatology Research University of California San Francisco Recorded on April

More information

HEPATITIS C TREATMENT GUIDELINES

HEPATITIS C TREATMENT GUIDELINES HEPATITIS C TREATMENT GUIDELINES Updated May 21, 2014 INSTRUCTIONS: 1. Review the posted Hepatitis C Treatment Guidelines document to validate that your patient meets the criteria for treatment. 2. Complete

More information

Hepatitis C Class Review

Hepatitis C Class Review Hepatitis C Class Review Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35, Salem, Oregon 97301-1079 Phone 503-945-5220 Fax 503-947-1119 Month/Year of Review: January

More information

Molecular Diagnosis of Hepatitis B and Hepatitis D infections

Molecular Diagnosis of Hepatitis B and Hepatitis D infections Molecular Diagnosis of Hepatitis B and Hepatitis D infections Acute infection Detection of HBsAg in serum is a fundamental diagnostic marker of HBV infection HBsAg shows a strong correlation with HBV replication

More information

Objectives. Hepatitis C: The new era of screening and treatment. Distribution of HCV genotypes 11/1/2014. History of HCV diagnosis and screening

Objectives. Hepatitis C: The new era of screening and treatment. Distribution of HCV genotypes 11/1/2014. History of HCV diagnosis and screening Objectives Hepatitis C: The new era of screening and treatment David Crabb, M.D. Department of Medicine, Indiana University and Eskenazi Health Describe the natural history of HCV infection Be able to

More information

boceprevir 200mg capsule (Victrelis ) Treatment experienced patients SMC No. (722/11) Merck, Sharpe and Dohme Ltd

boceprevir 200mg capsule (Victrelis ) Treatment experienced patients SMC No. (722/11) Merck, Sharpe and Dohme Ltd boceprevir 200mg capsule (Victrelis ) Treatment experienced patients SMC No. (722/11) Merck, Sharpe and Dohme Ltd 09 September 2011 The Scottish Medicines Consortium (SMC) has completed its assessment

More information

PARTNERSHIP HEALTHPLAN OF CALIFORNIA

PARTNERSHIP HEALTHPLAN OF CALIFORNIA Authorization for the Treatment of Hepatitis C 4665 Business Center Drive Fairfield, California 94534 July 1, 2016 Re: Authorization for the use of Sovaldi/Harvoni/Viekira Pak/Daklinza/Technivie/Zepatier/Epclusa

More information

Hepatitis C Treatment Advocacy: Ireland. Brian O Mahony

Hepatitis C Treatment Advocacy: Ireland. Brian O Mahony Hepatitis C Treatment Advocacy: Ireland Brian O Mahony Haemophilia and Hepatitis C 775 people with Haemophilia in Ireland 252 people with Haemophilia infected with Hepatitis C before 1992 106 of these

More information

Hepatitis Update. Study 110: SVR at post-treatment week 24 (SVR24) Jürgen Rockstroh, MD. No ART EFV/TDF/FTC ART/r/TDF/FTC Total

Hepatitis Update. Study 110: SVR at post-treatment week 24 (SVR24) Jürgen Rockstroh, MD. No ART EFV/TDF/FTC ART/r/TDF/FTC Total Hepatitis Update Jürgen Rockstroh, MD Study 11: SVR at post-treatment week 24 (SVR24) Patients with Undetectable HCV RNA (Percentage) 8 7 6 5 4 3 2 1 71 No ART EFV/TDF/FTC ART/r/TDF/FTC Total 69 8 74 n/n

More information

Introduction. Background

Introduction. Background INFORMATION DRIVES SOUND ANALYSIS, INSIGHT PHARMACY BENEFIT ADVISORY Introduction According to the Centers for Disease Control and Prevention (CDC), the rate of new hepatitis C virus (HCV) infections in

More information

NEW DRUGS FOR THE TREATMENT OF HEPATITIS C. Marcella Honkonen, PharmD, BCPS AzPA Annual Convention. Sunday, June 29 th, 2014 (1:15-2:15)

NEW DRUGS FOR THE TREATMENT OF HEPATITIS C. Marcella Honkonen, PharmD, BCPS AzPA Annual Convention. Sunday, June 29 th, 2014 (1:15-2:15) NEW DRUGS FOR THE TREATMENT OF HEPATITIS C Marcella Honkonen, PharmD, BCPS AzPA Annual Convention. Sunday, June 29 th, 2014 (1:15-2:15) Objectives Determine initial treatment options for patients with

More information

Debate: To Treat Now or Not to Treat Now. Age, Disease Stage, Resistance, and Comorbidities

Debate: To Treat Now or Not to Treat Now. Age, Disease Stage, Resistance, and Comorbidities Debate: To Treat Now or Not to Treat Now Age, Disease Stage, Resistance, and Comorbidities Moderator: Raymond T. Chung, MD Associate Professor of Medicine, Harvard Medical School Director of Hepatology

More information

Take Action Against Hepatitis C For People in Recovery From Mental Illness or Addiction

Take Action Against Hepatitis C For People in Recovery From Mental Illness or Addiction Take Action Against Hepatitis C For People in Recovery From Mental Illness or Addiction Attention treatment providers in behavioral health programs! This booklet is intended for use with clients who: Are

More information

2015 Outpatient Chronic Hepatitis B Management

2015 Outpatient Chronic Hepatitis B Management 2015 Outpatient Chronic Hepatitis B Management Hepatitis B Hepatitis B Info 70% of acute infections are subclinical More severe symptoms when in addition to other liver disease Fulminant Hepatitis

More information

12/2/2015 HEPATITIS B AND HEPATITIS C BLOOD EXPOSURE OBJECTIVES VIRAL HEPATITIS

12/2/2015 HEPATITIS B AND HEPATITIS C BLOOD EXPOSURE OBJECTIVES VIRAL HEPATITIS HEPATITIS B AND HEPATITIS C BLOOD EXPOSURE DISEASE 101 ONLINE CONFERENCE SARAH WENINGER, MPH VIRAL HEPATITIS.STD.HIV PREVENTION COORDINATOR DECEMBER 3, 2015 OBJECTIVES Describe the populations that should

More information

boceprevir 200mg capsule (Victrelis ) Treatment naïve patients SMC No. (723/11) Merck Sharpe and Dohme Ltd

boceprevir 200mg capsule (Victrelis ) Treatment naïve patients SMC No. (723/11) Merck Sharpe and Dohme Ltd boceprevir 200mg capsule (Victrelis ) Treatment naïve patients SMC No. (723/11) Merck Sharpe and Dohme Ltd 09 September 2011 The Scottish Medicines Consortium (SMC) has completed its assessment of the

More information

The Epidemiology of Hepatitis A, B, and C

The Epidemiology of Hepatitis A, B, and C The Epidemiology of Hepatitis A, B, and C Jamie Berkes M.D. University of Illinois at Chicago jberkes@uic.edu Epidemiology: Definitions The study of the incidence and prevalence of diseases in large populations

More information

Hepatitis C in 2015. Primary Care Providers: Linkage to Care

Hepatitis C in 2015. Primary Care Providers: Linkage to Care Hepatitis C in 2015 Primary Care Providers: Linkage to Care Michael D Voigt Medical Director, Liver Failure and Transplantation University of Iowa, Hospitals and Clinics Disclosures I have NO disclosures

More information

HEPATITIS WEB STUDY Acute Hepatitis C Virus Infection: Epidemiology, Clinical Features, and Diagnosis

HEPATITIS WEB STUDY Acute Hepatitis C Virus Infection: Epidemiology, Clinical Features, and Diagnosis HEPATITIS WEB STUDY Acute C Virus Infection: Epidemiology, Clinical Features, and Diagnosis H. Nina Kim, MD Assistant Professor of Medicine Division of Infectious Diseases University of Washington School

More information

Recommendations 8/14/2014. Hepatitis C Clinical Approach Primary Care. Purpose of Presentation. HCV Prevalence Year of Birth

Recommendations 8/14/2014. Hepatitis C Clinical Approach Primary Care. Purpose of Presentation. HCV Prevalence Year of Birth Hepatitis C Clinical Approach Primary Care Dr. Vicki L. MIt McIntyre, FNP Tucson Gastroenterology Specialists Tucson, Arizona University of Phoenix Lead Faculty, Department of Nursing Tucson, Arizona Purpose

More information

An Approach to the Diagnosis and Treatment of Hepatitis C Virus Infection in 2015. Matthew McMahon, MD

An Approach to the Diagnosis and Treatment of Hepatitis C Virus Infection in 2015. Matthew McMahon, MD An Approach to the Diagnosis and Treatment of Hepatitis C Virus Infection in 2015 Matthew McMahon, MD In the United States, 2.2-3.2 million people are infected with the hepatitis C virus (HCV) Half unaware

More information

Recommendations for the Identification of Chronic Hepatitis C virus infection Among Persons Born During 1945-1965

Recommendations for the Identification of Chronic Hepatitis C virus infection Among Persons Born During 1945-1965 Recommendations for the Identification of Chronic Hepatitis C virus infection Among Persons Born During 1945-1965 MMWR August 17, 2012 Prepared by : The National Viral Hepatitis Technical Assistance Center

More information

HEPATITIS COINFECTIONS

HEPATITIS COINFECTIONS HEPATITIS COINFECTIONS Kenneth E. Sherman, MD, PhD Gould Professor of Medicine Director, Division of Digestive Diseases University of Cincinnati College of Medicine Disclosures (Activity w/i 12 months)

More information

Senate Fiscal Agency IMPLICATIONS FOR THE STATE OF MICHIGAN OF NEW HEPATITIS C TREATMENTS

Senate Fiscal Agency IMPLICATIONS FOR THE STATE OF MICHIGAN OF NEW HEPATITIS C TREATMENTS Issue Paper PAPERS EXAMINING CRITICAL ISSUES FACING THE MICHIGAN LEGISLATURE Senate Fiscal Agency IMPLICATIONS FOR THE STATE OF MICHIGAN OF NEW HEPATITIS C TREATMENTS by Ellyn Ackerman, Fiscal Analyst

More information

HEPATITIS C DISCUSSION GUIDE:

HEPATITIS C DISCUSSION GUIDE: HEPATITIS C DISCUSSION GUIDE: INFORMATION AND ANSWERS TO AID YOUR COUNSELING OF PATIENTS INDICATION HARVONI is indicated for the treatment of chronic hepatitis C (CHC) genotype 1 infection in adults. Warnings

More information

Case Finding for Hepatitis B and Hepatitis C

Case Finding for Hepatitis B and Hepatitis C Case Finding for Hepatitis B and Hepatitis C John W. Ward, M.D. Division of Viral Hepatitis Centers for Disease Control and Prevention Atlanta, Georgia, USA Division of Viral Hepatitis National Center

More information

Hepatitis C Virus Direct-Acting Antivirals Prior Authorization Request Form

Hepatitis C Virus Direct-Acting Antivirals Prior Authorization Request Form Hepatitis C Virus Direct-Acting Antivirals Prior Authorization Request Form For assistance, please call 1-855-552-6028 or fax completed form to 570-271-5610. Medical documentation may be requested. This

More information

Epidemiology of Hepatitis C Infection. Pablo Barreiro Service of Infectious Diseases Hospital Carlos III, Madrid

Epidemiology of Hepatitis C Infection. Pablo Barreiro Service of Infectious Diseases Hospital Carlos III, Madrid Epidemiology of Hepatitis C Infection Pablo Barreiro Service of Infectious Diseases Hospital Carlos III, Madrid Worldwide Prevalence of Hepatitis C 10% No data available WHO.

More information

PREVENTION OF HCC BY HEPATITIS C TREATMENT. Morris Sherman University of Toronto

PREVENTION OF HCC BY HEPATITIS C TREATMENT. Morris Sherman University of Toronto PREVENTION OF HCC BY HEPATITIS C TREATMENT Morris Sherman University of Toronto Pathogenesis of HCC in chronic hepatitis C Injury cirrhosis HCC Injury cirrhosis HCC Time The Ideal Study Prospective randomized

More information

The most serious symptoms of this stage are:

The most serious symptoms of this stage are: The Natural Progression of Hepatitis C The natural history of hepatitis C looks at the likely outcomes for people infected with the virus if there is no medical intervention. However, the process of trying

More information

Hepatitis C - genotype 2/3

Hepatitis C - genotype 2/3 Hepatitis C - genotype 2/3 Information for you Follow us on Twitter @NHSaaa Find us on Facebook at www.facebook.com/nhsaaa Visit our website: www.nhsaaa.net All our publications are available in other

More information

Hepatitis C. Screening, Diagnosis and Linkage to Care

Hepatitis C. Screening, Diagnosis and Linkage to Care Hepatitis C Screening, Diagnosis and Linkage to Care Diagnosis If your hepatitis C antibody test is reactive, a second test will be needed to diagnose and determine if you are currently infected. Screening

More information

When an occupational exposure occurs, the source patient should be evaluated for both hepatitis B and hepatitis C. (AII)

When an occupational exposure occurs, the source patient should be evaluated for both hepatitis B and hepatitis C. (AII) XI. OCCUPATIONAL EXPOSURES TO HEPATITIS B AND C RECOMMENDATION: When an occupational exposure occurs, the source patient should be evaluated for both hepatitis B and hepatitis C. (AII) The risk of transmission

More information

Hepatitis C Virus Infection in Massachusetts: A tale of two epidemics

Hepatitis C Virus Infection in Massachusetts: A tale of two epidemics Hepatitis C Virus Infection in Massachusetts: A tale of two epidemics Daniel Church, MPH Massachusetts Department of Public Health Bureau of Infectious Disease 1 Goals of presentation Provide an overview

More information

L hépatite virale C en Médecine Familiale- Rurale Montréal-Québec Mai 2015

L hépatite virale C en Médecine Familiale- Rurale Montréal-Québec Mai 2015 L hépatite virale C en Médecine Familiale- Rurale Montréal-Québec Mai 2015 Demographics Luis Rivero Pinelo MD LMCC, CCFP, FCFP, Fellow SRPC, CSPQ Shawville- Québec Aux États Unis, la prévalence est présente

More information

MEDICAL ASSISTANCE HANDBOOK PRIOR AUTHORIZATION OF PHARMACEUTICAL SERVICES. I. Requirements for Prior Authorization of Hepatitis C Agents

MEDICAL ASSISTANCE HANDBOOK PRIOR AUTHORIZATION OF PHARMACEUTICAL SERVICES. I. Requirements for Prior Authorization of Hepatitis C Agents MEDICAL ASSISTANCE HBOOK PRI AUTHIZATION OF PHARMACEUTICAL SERVICES I. Requirements for Prior Authorization of Hepatitis C Agents A. Prescriptions That Require Prior Authorization Prescriptions for Interferon,

More information

A Proposal for Managing the Harvoni Wave June 22, 2015

A Proposal for Managing the Harvoni Wave June 22, 2015 A Proposal for Managing the Harvoni Wave June 22, 2015 Clinical Background Hepatitis C is an infectious disease caused by the Hepatitis C Virus (HCV) that damages the liver over time. The disease affects

More information

Hepatitis C Infection In Singapore

Hepatitis C Infection In Singapore Hepatitis C Infection In Singapore Richard Guan MBBS, MRCP(UK), FAMS(Gastro), FRCP(Edin), FRCP(Lond) Gastroenterologist & Hepatologist, Mt Elizabeth Medical Centre, Singapore Summary of HCV treatment practice

More information

Viral Hepatitis Case Report

Viral Hepatitis Case Report Page 1 of 9 Viral Hepatitis Case Report Perinatal Hepatitis B Virus Infection Michigan Department of Community Health Communicable Disease Division Investigation Information Investigation ID Onset Date

More information

HCV Treatment Failure

HCV Treatment Failure بسم االله الرحمن الرحيم HCV Treatment Failure Gamal Esmat PROF.OF HEPATOLOGY&TROPICAL MEDICINE CAIRO UNIVERSITY Director of Viral Hepatitis Treatment Centers (VHTCs( VHTCs) MOH-EGYPT www.gamalesmat.com

More information

What does Hepatitis C mean to me as a CKD Patient?

What does Hepatitis C mean to me as a CKD Patient? What does Hepatitis C mean to me as a CKD Patient? Clinical Practice Guidelines for the Prevention, Diagnosis, Evaluation and Treatment of Hepatitis C in CKD Introduction Worldwide, about 170 million people

More information

Using Electronic Medical Record Decision Support to Increase Testing for Hepatitis C

Using Electronic Medical Record Decision Support to Increase Testing for Hepatitis C Using Electronic Medical Record Decision Support to Increase Testing for Hepatitis C Camilla S. Graham, MD, MPH Division of Infectious Diseases Beth Israel Deaconess Medical Center None Disclosures Advantages

More information

Hepatitis E virus and chronic hepatitis in organ-transplant recipients

Hepatitis E virus and chronic hepatitis in organ-transplant recipients Hepatitis E virus and chronic hepatitis in organ-transplant recipients Nassim Kamar MD, PhD Department of Nephrology, Dialysis and Multi-Organ Transplantation Toulouse University Hospital Antwerp, 13/3/2009

More information

Management of hepatitis C: pre- and post-liver transplantation. Piyawat Komolmit Bangkok

Management of hepatitis C: pre- and post-liver transplantation. Piyawat Komolmit Bangkok Management of hepatitis C: pre- and post-liver transplantation Piyawat Komolmit Bangkok Liver transplantation and CHC Cirrhosis secondary to HCV is the leading cause of liver transplantation in the US

More information

Clinical Guidelines for the Medical Management of Hepatitis C

Clinical Guidelines for the Medical Management of Hepatitis C New York State Department of Health Clinical Guidelines for the Medical Management of Hepatitis C Condensed Version, Tables and Figures 2005 Risk Assessment and Screening Persons at increased risk for

More information

Burden of hepatitis C in Europe the case of France and Romania

Burden of hepatitis C in Europe the case of France and Romania Burden of hepatitis C in Europe the case of France and Romania Presented to: European Liver Patients Association Version: Final version 2.3 Date: 2015-03-26 Table of contents 1. Executive summary... 5

More information