Hepatitis C

Transcript: Vincent Lo Re, MD, on Overcoming the Barriers to Hepatitis C Virus Cure

Amanda Balbi: Hello everyone, and welcome to another installment of Podcasts360—your go-to resource for medical news and clinical updates. I’m your moderator, Amanda Balbi with Consultant360 Specialty Network.

Nearly 2.4 million individuals in the United States—1% of the adult population—were living with hepatitis C virus (or HCV) from 2013 through 2016, according to estimates from the Centers for Disease Control and Prevention. In 2016, the World Health Organization committed to eliminating viral hepatitis as a public health threat by setting goals of reducing mortality by 65% and reducing new infections by 80% by 2030, compared with 2015 rates.

With us today to talk more about HCV is Dr Vincent Lo Re, who is an associate professor of medicine (Infectious Diseases) and Epidemiology at the University of Pennsylvania, senior scholar in the Penn Center for Clinical Epidemiology and Biostatistics, and codirector of the Penn Center for AIDS Research Clinical Core.

Thank you so much for joining me today, Dr Lo Re.

A recent study identified barriers to HCV direct-acting antiviral therapy. In your opinion what are the most common barriers to therapy, and how can they be overcome?

Vincent Lo Re: So I talked about some of the barriers, previously, to initiating HepC treatment, which is active alcohol and substance abuse, active injection drug use, and all of the issues that are surrounding the lack of interest in providers to dispense treatment to these individuals.

Depending on the region that people are living in or practicing in, I think there have been concerns that chronic kidney disease itself may be barrier. I would say that's normal. I don't think that should be the case any longer.

We have direct-acting antivirals, that are very well-tolerated, even in patients with advanced chronic kidney disease or on haemodialysis. In some areas, HIV coinfection has been a barrier, and that too is actually something we should make sure not to, because patients with HIV, hepatitis C really have high rates of end-stage liver disease, even despite antiretroviral therapy and even despite fully suppressed HIV. So, if anything, that is another subgroup in which antiviral treatment for chronic hepatitis should be really focus.

I mentioned that another barrier to treatment in some regions is the insurers themselves and the restrictive criteria for reimbursement that have led to denials and lack of patients having received these direct-acting antivirals.

All of these should not be barriers in 2020, but unfortunately they still remain to be buried.

Amanda Balbi: If you could answer one research question by the end of your career, what would it be?

Vincent Lo Re: That's a great question. At this point, the biggest issue with hepatitis C, the biggest goal, is elimination. We have direct-acting antivirals that are highly potent with over 95% chance of cure. Very well-tolerable. But the data would suggest that only 15% to 20% of individuals are receiving them at this point.

In my own career, where I was initially focused on, and I still am to a great degree focusing on the biology of how HIV and various cofactors like hepatitis B, metabolic diseases, medications can impact liver disease progression. I think one of the key questions to answer in my career is, “How can we maximize engagement of patients across the hepatitis C care continuum?”

How can we, whether it is to enhance approaches to diagnosis linkage into care, dispensing antiviral treatment, ensuring that patients will adhere to their antiviral regimen, and bringing them back to confirm that they are cured, and trying to institute interventions to prevent reinfection.

I think maximizing the engagement across that hepatitis C care continuum will really help us to achieve the WHO’s hepatitis C elimination goals and ultimately could reduce hepatitis C to a condition that is a normal public health threat.

To me, the biggest question to answer the gaps in the current hepatitis C care continuum is something that I'm still trying to achieve. I'm engaged now in a project where we're measuring the hepatitis C engagement in the hepatitis C care continuum in a large commercial insurance database, because it hasn't been done since our group did it in 2014 in a large scale in this country.

That kind of research is crucial to helping us reduce the overall number of people with chronic hepatitis C and preventing the downstream complications of liver disease, cirrhosis, liver compensation, and liver cancer.

Amanda Balbi: Thank you so much for speaking with me today and answering all my questions.

Vincent Lo Re: Well, it was my pleasure. And I hope that some of the information that was gleaned in this conversation will help other health care providers to treat more patients with hepatitis C and get them through the hepatitis C care continuum, so that we can reduce the overall prevalence of hepatitis C and reduce the likelihood of end-stage liver disease and other liver complications.