WILL TREATMENT OF HEPATITIS
C CAUSE CONFLICT AMONG
PHYSICIANS?
Thomas James III, MD
T
here is dissension in the ranks of practicing physicians. Treatment of one
disease—Hepatitis C—threatens to
take resources from the management of other
medical and surgical conditions. That sounds
like a very brash statement, but it is one being
openly discussed inside the beltway. Hepatitis
C is the most common chronic blood borne
infection in this country. CDC estimates that
3 ½ to 4 million Americans have chronic infection with this virus.
But this estimate may be an underestimation. The US Preventive
Services Task Force (USPSTF) in 2013 issued recommendations
based upon Level B evidence that all adults born between 1945 and
1965 have a one-time screening for Hepatitis C (HCV), along with
a screen for HIV. The USPSTF apparently feels that Baby Boomers
lived an especially more hedonistic life style in their youth, to create
greater risk than other age group segments. Right upon the heels
of the USPSTF’s pronouncement, CMS issued coverage guidelines
allowing coverage of a one-time screen for Hepatitis C in Medicare
beneficiaries who meet one of these conditions (1.):
14
•
Those at high risk because they have a current or past history
of illicit injection drug use
•
Those who had a blood transfusion before 1992, or
•
Those born between 1945 and 1965
LOUISVILLE MEDICINE
With greater screening the numbers of individuals identified
as infected with HCV is likely to rise. At the same time that mass
screening is occurring, treatments are being more effective, easier
to administer, and associated with a more benign side-effect profile.
The days of Pegylated interferon and ribavirin with 30-40 percent
sustained viral remission (SVR) have become supplanted by all
oral drug regiments with relatively higher to \