Sample: Which type of practitioner most often makes the diagnosis of HCV: Gastro? GP? Hepatologist? Other?
At first glance these 5 questions on hepatitis C virus (HCV) infection and its treatment may look simple-but you will probably pause to think before you answer. We also think you will find some interesting factoids in the background for each correct choice. Good luck.
Answer: D. Fatigue. Most individuals with chronic HCV are asymptomatic or minimally symptomatic. For those who do have symptoms, fatigue is often reported, and other less common symptoms include myalgia, arthralgia, and nausea and vomiting. In one online survey, 63% said they had fatigue at the time of diagnosis, while muscle aches came in second at 45%, and joint pain was in third place at 43%.
Answer: A. Family doctor or GP. In a survey of 798 US adults with HCV, 51% reported that they were diagnosed by a family doctor or GP, while 10% said they were diagnosed by a gastroenterologist. Other patients were diagnosed by internists/internal medicine physicians (9%), hepatologists (6%), infectious disease specialists (6%), or nurse practitioners (2%) among other healthcare providers.
Answer: A. Avoid alcohol or drink in moderation. When starting DAA therapy, individuals with HCV should also receive education on preventing further liver damage, according to current HCV guidelines. Most importantly, the potentially deleterious effects of alcohol should be emphasized, as multiple studies have shown a strong link between excessive consumption and liver fibrosis development or progression. Even brief interventions can reduce alcohol consumption and binge drinking, though individuals who are abusing alcohol or are dependent may need referral to a specialist who can address addiction issues.
Answer: F. All of the above. There are multiple measures recommended to prevent HCV transmission. Guidelines say infected individuals should be advised not to share toothbrushes, dental equipment, or shaving implements, and should cover bleeding wounds to limit the risk that others will come in contact with their blood. One part bleach to 9 parts water is recommended to clean up any visible blood from HCV-infected individuals on household implements or surfaces. HCV-infected individuals should stop using illicit injection drugs, and if they continue, they should be advised to not reuse or share syringes or other equipment used in drug preparation. In HIV-infected individuals, use of barrier precautions during sex can be advised to help limit potential risk of sexual transmission of HCV.
Answer: D. It's complicated. That said, here is what is not complicated: HCV therapy is cost-effective and its economic value has been proven in multiple recent studies. By contrast, the affordability issue is complex, as costs combined with high disease prevalence has led to limited access for some individuals. It is important to note that the well-publicized sticker prices of HCV drugs rarely reflect the actual price that insurers, government agencies, and PBMs pay, thanks to competition and negotiated pricing. Even so, it is hard to quantify the exact budgetary impact of HCV drugs, according to authors of recent HCV guidelines, who encouraged insurers, government, and drug manufacturers to work together to ensure all patients have access to treatment.