March 13, 2014
The growing concern about undetected hepatitis C infection, exciting developments in the management of the disease, and the realization that all healthcare providers — not just liver specialists — have a role to play in helping care for patients make the International Conference on Viral Hepatitis (ICVH) 2014 an important one for all stakeholders.
The conference will be held March 17 and 18 at the Icahn School of Medicine at Mount Sinai in New York City, and will be cohosted by the International Association of Providers of AIDS Care (IAPAC), in partnership with the International Association for the Study of the Liver (IASL).
"The conference presents an opportunity for a variety of clinicians — not just doctors, but pharmacists, nurses, and psychologists — to learn about the state of the art with respect to hepatitis B and hepatitis C, although at this point the highlights are in the hepatitis C area," José Zuniga, PhD, president of IAPAC, told Medscape Medical News.
The conference will help stakeholders gain valuable perspective on the tremendous progress that has been made in the management of hepatitis C in a variety of clinical practice settings, he said.
"Through the conference and the various means by which we disseminate the outcomes — whether it's the live webcasts, the archived webcasts, the coverage on Medscape, etcetera — our goal is to ultimately expand the universe of clinicians who are managing viral hepatitis, from screening to treatment and, in the case of hepatitis C, to cure," he said.
The recent development of new drugs has made treatment protocols for hepatitis C easier and successful, Dr. Zuniga said.
Paradigm Shift in Management of Hepatitis C
"Over the past several years, we have seen a complete paradigm shift in the clinical management of hepatitis C. That progress has continued through to looking at regimens that are interferon-sparing, meaning eliminating some of the side effects related to that specific drug," Dr. Zuniga said.
"We're also looking at more convenient dosing, which will make it as it is in the HIV world — much more possible for people to adhere to their regimens and ultimately achieve the goals of treatment, which in this instance is a cure."
Several presentations will offer information about treating hepatitis C patients in a general practice setting and stress the role of other members of the healthcare team, in addition to physicians.
“The universe of liver specialists is not capable of managing the hepatitis C epidemic in the United States, let alone globally.”
"These talks are extremely important because the universe of hepatologists and gastroenterologists — liver specialists — is not capable, from the shear perspective of volume of people, of managing the hepatitis C epidemic in the United States, let alone globally," Dr. Zuniga said.
"From our perspective as an association that represents a variety of providers, and now increasingly primary care physicians and clinicians, it's important that we provide them with the type of education that will allow them to screen, test, and treat," he explained.
"Any number of educational and structural interventions that will be discussed at the conference should make it easier to integrate larger numbers of nonliver specialists into the health workforce dealing with hepatitis," Dr. Zuniga noted.
A talk on the role of social workers in hepatitis C treatment is one that has been highlighted by conference organizers.
"To use the much-used cliché, it takes a village. We've learned this with HIV, and we're applying it to hepatitis. It's not just about the physician. In fact, at times, the physician is a barrier to the type of quality care that we want to deliver to people," Dr. Zuniga said.
"We know, for example, that if we want to improve adherence among patients on complicated regimens, or even lifetime regimens in the case of HIV, a nurse can do a far better job. Our interest as a group that represents all providers of HIV care, and by extension those who provide care to coinfected patients, is to ensure that the voices of nurses, pharmacists, psychologists, and peer educators are heard."
Baby Boomers Important Target for Screening
People born between 1945 and 1965 represent an important group for hepatitis C screening. Initiatives to increase awareness of screening in various settings, including emergency departments, will be discussed at the conference.
"Centers for Disease Control and Prevention guidelines focus screening activities on those most at risk, rather than on the general public. These guidelines have been out for a few years, and the US Preventative Services Task Force has endorsed them, which is a wonderful thing because it means that screening activities are reimbursed by insurance companies," Dr. Zuniga said.
This population is at risk because of a variety of risk-taking behaviors, such as injection drug use, that were prevalent when the baby boomers were coming of age. The lack of knowledge about hepatitis means that the bulk of these people have never been tested for hepatitis C.
The CDC has articulated deep concern about a potential wave of mortality related to liver cancers in undiagnosed baby boomers within the next 5 to 10 years.
"This is extremely frightening," Dr. Zuniga said. "Large numbers of people could be diagnosed with late-stage liver disease. That is why we are trying to educate as many clinicians as possible on the continuum of hepatitis C care.
There has been talk about the possibility of eradicating hepatitis C, at least in resource-rich settings like the United States and Western Europe. But that is not going to happen without the workforce, the infrastructure, and the financial resources to implement a robust response, Dr. Zuniga said.
"Amazing" Time in Hepatitis C
Meeting cochair Douglas Dieterich, MD, from the Icahn School of Medicine at Mount Sinai, told Medscape Medical News that this is an amazing time in hepatitis C, "both from the perspective of the CDC recommendations for screening baby boomers and the New York State law for screening baby boomers, and the confluence of new therapies that are all extremely effective, approaching 100% cure rates with virtually no side effects."
Because of these developments, there is now a growing need to equip more healthcare providers with the tools to manage patients, Dr. Dieterich explained. "We are going to need more providers who are able to treat hepatitis C and, of course, more primary care people who are willing to screen for hepatitis C and refer for treatment to gastroenterologists or liver specialists if they're not comfortable treating it themselves," he said.
Dr. Dieterich added that there will be a huge need for hepatitis C education in the primary care, infectious disease, HIV, gastrointestinal, and liver communities for the next decade or so.
Dr. Zuniga noted that the fact that the meeting is being held in partnership with the IASL is important.
"A liver association and an HIV association wanted to get together to communicate to the world that it's okay for liver specialists and nonliver specialists to work together to eradicate hepatitis," he said. "There is a gulf between the liver world and the nonliver world that we are trying to bridge. Given the magnitude of the epidemic and the health workforce restraints we have because of the numbers who can actually treat at this moment, this is a very powerful message that our associations are sending."
Dr. Zuniga and Dr. Dieterich have disclosed no relevant financial relationships.