San Francisco VA Health Care System
New, Better Treatments Available for Hepatitis C
Since 2013, Hepatitis C Virus (HCV) treatment has changed significantly with approval of six new agents or fixed drug combinations. These treatments are far better than any previously available, with cure rates of over 90 percent for most people.
“Until recently, available treatments were lengthy, had serious side effects, and didn’t work very well,” says Cyndi Bakir, Clinical Nurse Specialist (CNS), Liver Clinic Care Coordinator at the San Francisco VA Health Care System (SFVAHCS). “In comparison, the new treatments consist of pills only, cause minimal side effects, and have much better cure rates. The length of HCV treatment has decreased to 12 weeks for most people.”
Because of the high cost of these new drugs and the fact that liver damage progresses slowly in many patients, many organizations targeted patients for treatment only after significant scarring of the liver or early cirrhosis had occurred.
In contrast, SFVAHCS researchers contributed to work showing that the optimal time of treatment should be earlier. National guidelines have now evolved to allow treatment in everyone with HCV, and SFVAHCS encourages all patients with HCV to come for treatment.
“Curing the Hepatitis C virus stops ongoing damage to liver cells,” says Bakir. “Most people with Hepatitis C don’t have any symptoms. The only way to know if you have it is to request a blood test.”
Veterans enrolled in VA health care at the San Francisco VA Medical Center (SFVAMC) can call Bakir at (415) 221-4810, ext. 2-4771 and ask to be screened for HCV. Patients at our six VA community clinics (Eureka, Clearlake, Ukiah, Santa Rosa, San Francisco VA Downtown Clinic, and San Bruno), can call their primary care provider there and request a lab test for HCV. For community clinic patients, liver specialists conduct visits from SFVAMC using Video Telehealth through a novel program called SCAN-ECHO that assists local physicians in caring for patients with HCV. Medication and lab tests are available locally at the clinics.
The SFVAHCS Liver Clinic team also includes two Hepatologists, a nurse practitioner, a clinical pharmacist, and a psychologist. They hold clinics on multiple days of the week, including group treatment clinics and drop-in follow-up clinics. The SFVAHCS Infectious Disease Clinic also has a team of specialists that provide specialized care for Veterans with HIV and HCV co-infection, because of complex drug-to-drug interactions that can occur with the combination of HIV and Hep C treatments. The clinics work closely together to determine the optimal HCV treatment regimen for each Veteran.
Nationwide, the VA leads the country in hepatitis screening, testing, treatment, research, and prevention.
The SFVAHCS Liver Clinic team is a significant contributor and consultant for the VA’s National Hepatitis C Resource Center, where national educational products on HCV are developed, including treatment guidelines and clinical tools for providers, and medication handouts for patients. SFVAHCS investigators conduct research in partnership with the University of California, San Francisco, and other VAs around the country, fostering excellence and scientific collaboration among its members.
“Our message to Veterans is, get tested and get treated,” says Bakir. If you haven’t been tested for Hepatitis C, call me and I can arrange for you to be tested. Once you have your lab work done, I can speak with you on the phone and give you a snapshot of your liver health. If you want to come to our Liver Clinic, I can make your appointment. We want to make your access to care as easy as possible.”
For more information about Hepatitis, visit www.hepatitis.va.gov.