Strategies for Managing Hepatitis and HE

Liver disease often results from hepatitis that manifests as either an acute event or as a chronic condition, the latter of which can culminate in organ failure, need for transplant, and even death. Hepatitis C virus (HCV) is the most common form of hepatitis, but only one in four patients suffering from it gets diagnosed. The CDC recently recommended that anyone born between 1945 and 1965 receive HCV antibody testing. As many as 1 million new cases of chronic HCV may be uncovered with this dictum. Nonalcoholic fatty liver disease (NAFLD) is another important cause of hepatitis and is the most common cause of elevated liver function tests. It’s expected to become the most common indication for liver transplantation by 2020. Based on current trends in NAFLD, there is great cause for concern on how best to manage these patients. Importantly, cirrhosis is a stage of NAFLD that has been associated with hepatic encephalopathy (HE), a condition associated with cognitive impairment that significantly reduces quality of life (QOL). Symptoms of HE range from subtly altered mental status to deep coma. The cyclical nature of the illness can be difficult to break and doesn’t resolve completely until a transplant is received or the patient dies. The direct and indirect costs of managing HE are rising, and admissions for HE have increased significantly over the past 8 years. Additionally, patients suffering from HE tend to relapse, which can further exacerbate problems. Hepatitis Treatments Becoming More Effective Neomycin, lactulose, and rifaximin are the only FDA-approved treatments for HE, but the therapeutic paradigm is ever-changing. Historically, treatment for overt HE has begun when...
Hepatitis C Testing: Calling All Baby Boomers

Hepatitis C Testing: Calling All Baby Boomers

Nearly 5 million Americans are infected with hepatitis C, and more than 80% of these individuals are baby boomers. Alarmingly, 75% of people with hepatitis C aren’t aware they are infected. In August 2012, the CDC issued new guidelines recommending that all baby boomers (those born between 1945 and 1965) have a onetime test for hepatitis C. This could detect another 800,000 of those infected and potentially save 120,000 lives. Characterizing Hepatitis C Hepatitis C remains the only viral infection that can be cured, and this move toward broader testing comes at an important time as therapy continues to improve. Cure rates with protease inhibitors recently approved by the FDA range between 68% and 79%. For many patients, these therapies will cut treatment time in half. With more than 50 drugs in development, the cure rate is likely to improve to greater than 90% over the next 5 to 10 years, and therapy will be easier to tolerate and take less time to become effective. Testing Baby Boomers for Hepatitis C Testing for hepatitis C has been shown in studies to be cost-effective, especially as the epidemic costs the U.S. an estimated $30 billion per year. That number is projected to rise to $80 billion per year by 2025. Curing the majority of those affected will dramatically reduce those costs. Physicians should recognize that routine physical exams may not detect hepatitis C. Up to 40% of infected people will have normal liver blood tests, so a specific antibody test must be conducted. In addition to talking to baby boomers about hepatitis C testing, physicians should also discuss testing with...