We recently sat down to discuss current topics in management of hepatitic C virus (HCV) infection with Paul Kwo, MD, Professor of Medicine (Gastroenterology and Hepatology) at Stanford University Medical Center. Dr Kwo most recently was the lead author on the American College of Gastroenterology's clinical guideline on abnormal liver chemistries. Read on to hear Dr. Kwo’s thoughts on new HCV guideline updates, screening rates, and the evolving role of the gastroenterologist in HCV care.
The AASLD/IDSA guidelines have recently been updated to reflect new recommendations for women of reproductive age. Why is testing and management so important in this cohort?
Dr. Kwo: For years, when we thought of the HCV birth cohort, we thought of the baby boomer or Woodstock generation. The need for screening in that 1945 to 1965 birth cohort is well established. Now, there is a second HCV cohort between the ages of 20 to 39. We know this in part because of a report published in the Annals of Internal Medicine showing that the number of reproductive-aged women with acute and past or present HCV infection doubled from 2006 to 2014. This is unfortunately related primarily to our opiate epidemic. We are finding that because of widespread injection drug use, particularly heroin, many younger women of childbearing age have now contracted hepatitis C.
"...the number of reproductive-aged women with acute and past or present HCV infection doubled from 2006 to 2014. This is unfortunately related primarily to our opiate epidemic."
If we can find these individuals prior to pregnancy and achieve SVR with DAA therapy, we are going to reduce the spread of HCV to infants. The guidelines are now emphasizing this population so practitioners are aware of this as another opportunity to find undiagnosed hepatitis C. Specifically, the guidelines state that women of reproductive age with HCV should be counseled about the benefits of antiviral treatment, and that therapy before considering pregnancy should be considered to reduce the risk of transmission to offspring.
In addition, the guidelines recommend universal testing of pregnant women for HCV infection, so when we think of TORCH infections such as toxoplasmosis, rubella, and CMV, we need to be adding hepatitis C to this list. Obviously, we don't treat during pregnancy, but these are the individuals that should be referred immediately post-pregnancy for DAA therapy.