Nearly 4 million people in the United States have been infected with the hepatitis C virus (HCV).1-3 Although most patients who develop a chronic infection will remain asymptomatic and undiagnosed, many will eventually develop cirrhosis and be at high risk of serious liver decompensation or hepatocellular carcinoma. Over the next 2 decades, a large generational cohort of patients with chronic HCV infection–those who are currently in their 40s and 50s–will begin to show clinical signs of liver disease related to their chronic infection. This substantial projected increase in HCV-related liver morbidity and mortality will tax the resources of healthcare systems, both public and private, and of society.
Despite recent improvements in the treatment of patients with chronic HCV infection, a large proportion of these individuals still do not benefit from the availability of the effective combination regimens. Some patients are not diagnosed until they are already manifesting signs of advanced liver disease, and others may not be considered eligible for treatment or may have outright contraindications to therapy. But even many of those who do initiate therapy with the current standard of peginterferon alfa and ribavirin still do not achieve viral clearance. In some cases, this treatment failure can be traced to drug side effects and/or patient nonadherence to a long-term course of therapy. A substantial number of HCV treatment failures may be avoidable with increased attention to individualized patient management and counseling, careful monitoring, and aggressive management of side effects.
The purpose of this supplement is to help pharmacists and clinicians expand their knowledge of HCV and improve their services for patients who are initiating anti-HCV therapy. The goal is to optimize treatment outcomes and costs. Much of the information presented here is based on the current HCV management guidelines issued by the National Institutes of Health and the American Association for the Study of Liver Diseases (AASLD).4,5 This core information is also supplemented with background from the Centers for Disease Control and Prevention and with practical tips from 2 guest faculty during the course of their recent live call-in continuing medical/ pharmacy education session with clinicians and pharmacists.
Journal of Gastroenterology.
Bruce R. Bacon, MD, is the James F. King, MD Endowed Chair in Gastroenterology, and professor of internal medicine at Saint Louis University School of Medicine. He is also director of the Division of Gastroenterology and Hepatology at that university. From 1999 to 2003, Dr Bacon was the chair of the American Board of Internal Medicine's Sub-specialty Board for Gastroenterology, and in 2004 he was president of the AASLD. His research has focused on iron metabolism in the liver, and he has written more than 250 original articles, reviews, and book chapters. He has also served on several editorial boards, including that of and was the senior associate editor for the liver disease section of the
Journal of Hepatology
John G. McHutchison, MD, a professor of medicine at Duke University who is affiliated with the Division of Gastroenterology, is director of Gastroenterology/ Hepatology Research at the Duke Clinical Research Institute at Duke University Medical Center in Durham, North Carolina. Dr McHutchison is a member of several professional organizations, including the AASLD and the American Gastroenterology Association. Dr McHutchison has published worldwide in the field of liver diseases and is the author of numerous articles and book chapters on chronic hepatitis C infection. He is associate editor for the and serves on the editorial board of