Brianna Norton, DO, MPH, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, talks about challenges of Hepatitis C treatment.
Brianna Norton, DO, MPH, Albert Einstein College of Medicine/Montefiore Medical Center: I think that really the majority the core of the Hep. C epidemic is among people who use drugs. For a long time, the largest population was baby boomers and now because of the expanding opioid epidemic in the US there's actually a lot of younger people who are acquiring Hep. C. In many states there's been a greater than 200% increase of new Hep. C infections and they're primarily people who inject drugs. And so it's going to be very important if we want to talk about potentially eliminating Hep. C in this country or reducing Hep. C prevalence dramatically, we're really going to have to reach out to people who use drugs. And I think one of the best ways to do that is to try to integrate drug treatment with Hep. C treatment. So if people are coming into methadone clinics we should be able to offer them the methadone treatment but also offer them Hep. C treatment, and vice versa if people are coming into an ID clinic or primary care clinic for Hep. C treatment, then being able to offer offer them buprenorphine treatment for their opioid use disorder or at least, having the ability to link them to drug treatment is going to be crucial, if we really want to make an impact in this disease.
I honestly think at this point the most difficult barrier to Hep. C treatment is actually linking to initiation. What we've seen now over and over both, in large pharmaceutical trial, the elbasvir/grazoprevir trial, the Merck trial, where they only enrolled people on opioid substitution therapy, the cure rates were amazing in that. There's the PREVAIL study that was just presented a couple of weeks ago at INSU conference, again, treating people in methadone clinic — all the SPR eats were greater than 90%. And the SIMPLIFY study which is going to be published soon, and was presented also a couple of weeks ago, just enrolled people who have injected drugs in the last 3 months and the cure rates were again greater than 95%. So when we're even talking about people with potentially chaotic lives, street homelessness, active drug users, cure rates are great. This is 1 pill a day we're talking about, so for most regimens. So I think what the biggest problem in terms of Hep. C treatment is actually getting people linked to care, and right now we don't. Our primary platform to do that is in specialty care, hepatologists, and although hepatologists are great Hep. C docs, I think if we're going to reach a larger portion we need to be treating in our HIV clinics, in our ID clinics, and our primary care clinics, and really reaching a broader breadth of people.