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AASLD President's Choice Lecture: The National Strategy for the Control of Viral Hepatitis and Liver by Dr Howard Koh, HHS
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from Jules: I did not attend the session where Koh spoke nor the post-talk meeting he had with community at conference because it conflicted with a clinical session. I was told by many who attended both sessions they were disappointed because they felt his talk & discussion lacked substance and because he has yet to promise funding although there is a reference to funding below. Many observers feel there will be no federal funding directly for desperately hepatitis C services, there is no formal infrastructure locally in cities nor nationally as there is in HIV with the Ryan White Care Act. It's estimated 2/3 of HCV-infected remain undiagnosed so large-scale testing programs are needed. It's estimated there are8-9 million HCV-infected in the USA, much more than the 4 million estimated by the CDC or the 5 million estimated by others, this is felt to be because of immigrants infected in their country of origin by unsanitary syringes from countries including Russia, Egypt, Far East (Chinese, Korea), Near East (Afghanistan, Pakistan). HCV therapy including peg/rbv is very hard to tolerate, affects disproportionately very marginalized patent populations, intensive support services are key for successful therapy for patients, intensive education is required for patients & clinicians because the new therapies have serious complexities to achieve optimal use including 'response-guided therapy' which will require testing HCV viral load at several key time-points after starting HCV therapy where treatment decisions on whether to stop or continue will have to be made and this will require patient cooperation & clinician education, side effects management will be important as although telaprevir & boceprevir are effective they are associated with side effects including rash management for telaprevir and anemia management for both but more for boceprevir with about 43% on boceprevir in phase 3 studies experiencing low hemoglobin. There will be education programs from thought leaders as we get close to launching these 2 drugs but will they be adequate as many clinicians & patients are at the fringes of the outreach for these programs. So government supported programs & infrastructure are desperately needed. In clinical development are 20 HCV orally administered drugs, we are headed towards multi-drug oral regimens of 2-4 orals with or without peg/rbv with expectations of very high cure rates approaching 100%, and increasingly duration of terapy which at some point will I think be 12 weeks or perhaps less for some patients so even if ribavirin or peg/rbv remain required for therapy such short therapy duration is a great improvement.
Dr. Howard Koh, the 14th Assistant Secretary for Health for the U.S. Department of Health and Human Services (HHS), described the steps the U.S. administration is taking in response to the recent Institute of Medicine (IOM) report on viral hepatitis in his 2010 President's Choice Lecture at The Liver Meeting, the annual meeting of the American Association for the Study of Liver Diseases (AASLD). Dr. Koh formed and led a U.S. Department of Health and Human Services-wide team that will soon issue a hepatitis action plan that will leverage new funding opportunities and integrate activities throughout HHS to build true systems of care for high-risk individuals.
Additionally, the plan will be used to strengthen partnerships with federal, professional, and patient organizations in an effort to set and implement policies to guide public health and clinical practice. Other goals of the plan will be to harmonize screening guidelines, create new strategies for workforce development, and improve hepatitis B vaccination rates for adults at high risk. Dr. Koh stressed the need for collaboration in addressing the epidemic of hepatitis, including the need to work with state and local health leaders and create stronger links with professional societies such as AASLD. The report will address the need for prevention and building the capacity for reducing the number and incidence of viral hepatitis infections and improving the health of patients and economic consequences of viral hepatitis.
Dr. Koh also praised the recent Trust for America's Health report developed in collaboration with AASLD that translates the IOM report into language that may be used to affect appropriations to support research and health care delivery for liver disease and also to be used in future legislation to make the screening, early detection, and treatment of viral hepatitis a reality.
Viral hepatitis is the fourth leading infectious cause of death, but is virtually unknown to health care providers, the general public, at-risk populations, and policymakers. Individuals with viral hepatitis are at increased risk for liver cancer and chronic liver disease, yet an estimated 70 percent of persons with chronic viral hepatitis do not know that they are infected. In the absence of appropriate treatment, 15 to 40 percent of infected persons will develop liver cirrhosis; viral hepatitis is also the leading cause of liver transplantation in the U.S. In addition, liver cancer rates have tripled over the last several decades in contrast to other types of cancer. Surveillance data suggest that nearly 20,000 people are newly infected with HCV every year.
Recent developments in many health-related areas can potentially contribute to lower rates of chronic hepatitis virus in the U.S. and improve health outcomes for infected persons. The HHS action plan reflects upon feedback received from both experts and the community, and will help HHS improve its existing efforts to prevent viral hepatitis and related disease in the following three ways:
* Establishing priorities for the specific actions that must be taken, assigning lead and partner agencies with responsibility for meeting these priorities
* Helping HHS build prevention and care capacity and improving the efficiency of current efforts through improved coordination of viral hepatitis activities across HHS operating divisions
* Serving as a guide for HHS to engage other governmental agencies and nongovernmental organizations in viral hepatitis prevention and care
This action plan is organized into the following six topic areas, which correspond to IOM recommendations:
* Increasing community awareness and provider education
* Strengthening surveillance for viral hepatitis
* Preventing viral hepatitis associated with injection-drug use
* Preventing viral hepatitis transmission through vaccination
* Preventing health care associated viral hepatitis
* Improving screening, care, and treatment for viral hepatitis
About the AASLD
AASLD is the leading medical organization for advancing the science and practice of hepatology. Founded by physicians in 1950, AASLD's vision is to prevent and cure liver diseases. This year's Liver Meeting, held in Boston, Massachusetts, October 29- November 2, will bring together more than 7,500 researchers from 55 countries.
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