Specialty considerations in management of hepatitis C

Abstract Objective To provide an update on chronic hepatitis C virus (HCV) infections and the challenges of HCV management, using clinical case vignettes. Data sources Clinical guidelines from the American Association for the Study of Liver Diseases/Infectious Diseases Society of America, U.S. prescribing information, PubMed articles, and patient advocacy websites. Study selection At the authors' discretion based on relevance of information presented. Summary Despite the availability of curative therapies, chronic HCV infections pose a substantial health care burden. Interest in chronic HCV management increased with new drug approvals; however, concerns about cost of therapy continue to limit patient access to treatment. Criteria used to determine HCV treatment candidacy, including staging of liver disease and need for liver biopsy, alcohol and substance abuse screening, ability to use short-course therapy, challenges of geno-type 3 infection, and the potential pitfalls of strict restrictions during HCV therapy, are examined using clinical case scenarios. Although access to HCV therapy is improving nationally, restrictions continue to vary by state and payer. Conclusion Despite increasing options for highly effective HCV therapy, the HCV treatment landscape remains a dynamic challenge. Pharmacists need to be familiar with current treatment guidelines to successfully navigate patients into treatment and ultimately, to cure HCV infections.