Treating Chronic Hepatitis C in the Primary Care Setting

Abstract

The National Institutes of Health and other institutions have emphasized the need to expand access to treatment of chronic hepatitis C virus infection to a larger and more diverse patient population. To begin to address this need, the divisions of General Internal Medicine and Liver Diseases of the Mount Sinai Medical Center created a program to identify patients who might benefit from hepatitis C treatment, to treat uncomplicated patients in the primary care setting, and to refer appropriate patients to liver disease specialists. Preliminary data from this program suggest that primary care-based treatment of chronic hepatitis C may offer unique advantages. The primary care setting allows special needs to be addressed and allows comprehensive services to be provided. Patients are guided through the complex pretreatment evaluation process, and non-liver-related comorbidities are managed. Our program may provide a useful model for increasing hepatitis C literacy among primary care providers and for extending treatment to a broader population of patients with hepatitis C.

A Systematic Review of Provider Knowledge of Hepatitis C: Is it Enough for a Complex Disease?

“…Yet, for the studies examined for this review, the data related to HCV appear to be mixed. Targeted educational efforts about hepatitis C led to short-term gains in knowledge as shown by several studies [25,49]. The simple dissemination of comprehensive guidelines about hepatitis C was not effective [22,27].…”

Managing Chronic Hepatitis C in Primary-Care Settings: More than Antiviral Therapy

“…Primary-care settings are well suited to providing care for people with chronic hepatitis C because primary care (1) is much more widely available than specialty care, (2) can create and sustain a long-term relationship between patients and care providers, and (3) provides comprehensive care that addresses a patient's physical, behavioral, and family/community needs. [19][20][21][22] AnTivirAl HCv TreATMenT: An iMPorTAnT ASPeCT of HePATiTiS C CAre THAT iS PoTenTiAlly life-SAving Current antiviral treatment regimens can achieve SVR (i.e., reduction of HCV below detectable levels at six months after the end of treatment) in up to 50% of people with the most common genotype (type 1) and up to 80% of people with other genotypes (types 2 and 3). 23 Although HCV can be detected by more sensitive assays in some patients with SVR, 24 most patients who achieve SVR appear at very low risk of HCV infection relapse and may be thought to have achieved a clinical cure of the HCV infection.…”

The Nervous System and Hepatitis C Virus

“…This brief review focuses on neuropsychologic and neurologic disorders associated with infection, and the evidence for nervous system localization of HCV. Psychiatric abnormalities (lability of affect, atypical emotional responses, anxiety, and depression) have been reviewed in another article in this issue (McGinn et al, 1 this issue).…”