Selected Podcast
Hepatitis C Care at UK HealthCare
Dr. Jens Rosenau discusses Hep C diagnosis, patient treatment, and who is at risk.
Featured Speaker:
After receiving his medical degree from Hanover Medical School in Germany, he continued to work there in the Division of Gastroenterology and Hepatology for almost 10 years, contributing to the one of the highest output hepatology research divisions in Germany and one of the largest transplant programs in Europe.
Dr. Rosenau has authored several clinical research articles. He is on editorial boards of international medical journals and an active as a peer reviewer.
Jens Rosenau, MD
Jens Rosenau specializes in general hepatology, with a focus on viral hepatitis, hepatocellular carcinoma, and the management of pre- and post-liver transplant patients.After receiving his medical degree from Hanover Medical School in Germany, he continued to work there in the Division of Gastroenterology and Hepatology for almost 10 years, contributing to the one of the highest output hepatology research divisions in Germany and one of the largest transplant programs in Europe.
Dr. Rosenau has authored several clinical research articles. He is on editorial boards of international medical journals and an active as a peer reviewer.
Transcription:
Hepatitis C Care at UK HealthCare
Introduction: Another informational resource from UK healthcare. This is UK HealthCast, featuring conversations with our physicians and other healthcare providers. Here's Melanie Cole.
Melanie Cole: Welcome to UK HealthCast with the University of Kentucky Healthcare. I'm Melanie Cole, and today we're talking about hepatitis C and treatment options available at UK Healthcare. Joining me is Dr. Jen Rosenau. He's a Gastroenterologist in Digestive Diseases and Nutrition at UK Healthcare. Dr. Rosenau, it's a pleasure to have you join us today for the listeners. Can you please start by explaining what is hepatitis and telling us a little bit about the different types that we've heard about?
Dr. Rosenau: Hepatitis is inflammation of the liver. And there are different types of hepatitis viral, hepatitis C is one of those viral infections that can cause hepatitis, hepatitis B virus can cause hepatitis. And there are other forms of hepatitis, for example, autoimmune hepatitis, where your own immune system can attack the liver. There's alcoholic hepatitis, there's hepatitis from nonalcoholic fatty liver disease. So there are many different types of hepatitis, but as I understand, we will talk about hepatitis C today.
Host: Yes, we absolutely will. So give us a little brief overview of Hep C specifically and tell us the difference between chronic hepatitis C and acute?
Dr. Rosenau: Yeah, hepatitis C. If a patient gets infected with hepatitis C, many of the patients go through an acute phase in the very beginning of the disease. Sometimes this acute phase can be unnoticed. Sometimes there are symptoms associated with it. This acute phase, there can be symptoms that are unspecific, just like nausea, vomiting, abdominal pain, very unspecific symptoms. Sometimes patients become jaundice, they turn yellow. So it's a little bit more obvious, but many patients really never have symptoms. If the immune system does not eliminate the hepatitis in this acute phase, it can become chronic, and chronic hepatitis C is then typically not associated with any symptoms. It's usually completely asymptomatic, but the problem is that it can cause liver damage over time, which usually takes a long time. But there are some factors that can accelerate the course and the hepatitis can damage the liver.
Host: Well, then tell us who is at risk for hepatitis C and is it more prevalent in one race than another? Tell us the risk factors and who really needs to think about this?
Dr. Rosenau: Yeah. And there are multiple risk factors. It's easiest to keep in mind that hepatitis C is mostly transmitted through blood contact in some way. And what we see most of the time, these days is injection drug use as a cause for hepatitis C. So injection drug share, drug share needles sometimes with others. And then there is blood contact and the hepatitis C virus gets transmitted that way. I would say that it's definitely the most common cause of transmission these days. There were many other ways of transmission in the past, like blood transfusions or for example, hemodialysis, or there were smaller groups of patients who got infected in different ways. Nowadays really lot gets screened very well. And this transmission risk is minimized. There are other ways of transmission, for example, tattoos, especially tattoos in an unregulated setting where the equipment is not sterilized in an appropriate way. I've heard from some patients that can even happen in the regular life setting. But that is rare. I would say those are the most common ways of transmission. You may have heard that hepatitis C can also be sexually transmitted. That is actually rare, at least in heterosexual, I would say heterosexual contact. It's very unlikely to exceed hepatitis C that way, but men who have sex with men have a higher risk of transmission.
Host: So, then Dr. Rosenau how is it diagnosed? Is there a screening? And if so, who should get tested?
Dr. Rosenau: There's a screening test available and it's a very, very simple, most of the time a blood test that is used, or there are other tests coming up now. There is now a recommendation that everybody should get tested. So really anybody can ask the doctor, can I please be tested for hepatitis C. Once in a lifetime at least, these specific recommendations of just testing the at risk population were not very effective because doctors have a lot of things on their mind. States do not always think of hepatitis C. So they quite often really forget to ask these questions and go through these things with every single patient. Then eventually a recommendation came out that all baby boomers should be tested because we knew that the hepatitis C that's more prevalent in baby boomers. So people born between 1945 and 1965. And for some time that was the simplified recommendation. But then we have noticed in the last decade that a lot of younger people got infected and it has a lot to do with this epidemic of drug use, especially here in Kentucky. Now, finally, we have the recommendation that anybody irrespective of age or risk factors, can get tested.
Host: So, tell us a little bit about treatment options at UK Healthcare and how the University of Kentucky Healthcare has really taken the lead in getting people tested and treated in Kentucky?
Dr. Rosenau: The good news is we have very good treatment options available these days. So within the last probably five, six years, we got a lot of very good options, very effective options, so we can cure almost everybody now. And it's not only that these treatments are very effective with almost a hundred percent cure rate. These treatments also are very well tolerated. There are very few side effects with these new treatments and the treatment is short. So it just needs about eight to 12 weeks. And it's just pills. There are no more injections. So we used to have interferon, which needed to be injected. Interferon had a lot of side effects. Interferon did not work very well. So this is all history fortunately, now we have these highly effective options that are well tolerated and with very short courses and just pills that you have to take.
Host: Wow, isn't that amazing? So, as you're speaking about how treatment is easier for the patient than it was maybe 20 years ago, is this more cost effective for the patient and are more insurance companies now paying for treatment?
Dr. Rosenau: Well, interestingly, when these new treatments came out, they were expensive. They were more expensive than previous treatment we had. But if you calculate that the cure rates were also very high, the price was actually about the same, but since we had a surge in hepatitis C with more patients coming in and more patients interested in treatment, the cost became pretty high for the healthcare system. So there were many restrictions in place from insurances in the first year, so 2014, 2015, when these drugs came out. Prices have dropped since then. It has been shown very well that the treatment is very, very cost effective. It's actually even cost saving. So treating patients, saves in the long run, because if we don't treat, we may eventually get complications of liver disease. And that is far more expensive than treating at the very beginning. So insurances have now mostly removed their restrictions at least here in Kentucky. And that's very good news. So even Medicaid approved treatment, most of the time. As one little caveat, we still have problems, retreating patients. So we can treat the first time. But if patients get reinfected, it may be more difficult to get the treatment reapproved for a second course.
Host: Well then before we wrap up and it's just such an interesting topic Dr. Rosenau, can it be cured? And then you'd mentioned re-infection, can it be cured? And as you're saying that, can you tell us how we can reduce our risk of getting hepatitis C and what you want listeners to know about the care available and testing available at the University of Kentucky Healthcare?
Dr. Rosenau: Absolutely. The hepatitis C can be cured and we can cure almost every patient who comes into our doors now. And I have mentioned that these treatments are very well tolerated, shot treatment typically does get approved. Come to see us. We have an interdisciplinary team at the University of Kentucky, where treatment is driven by pharmacists. You will see a provider in our clinic who will discuss hepatitis C with you. We will find out how you got infected, when you got infected. We'll educate you about the possible course of hepatitis C, if it is not treated, we will discuss treatments. We will discuss drug interactions, potential side effects, all these things with you. So definitely if you were diagnosed with hepatitis C, come and see us. Risk reduction to not get reinfected is incredibly important, since treatments are expensive and the insurance may not approve re-treatment. So the most important thing is probably to engage in a drug rehab program. If you continue to use drugs for any reason, or if you slip and relapse and start using drugs again, the most important thing is really to do it in a safe way to prevent reinfection. So not sharing needles, not sharing equipment, getting tattoos in a regulated setting. Those are the most important things to prevent the hepatitis C comes back again. You cannot reinfect yourself. So it's a transmitted disease. So it needs somebody who transmits the disease. And most of the time that's sharing off equipment with drug use. If you avoid that, you should not get reinfected
Host: Such important information. Doctor, thank you so much for joining us today and sharing your expertise. This is such an important topic. And that concludes another episode of UK HealthCast with the University of Kentucky Healthcare. For more information on hepatitis C and the treatment options available, please visit our website at ukhealthcare.uky.edu, and look up digestive health program, hepatitis C. Please remember to subscribe, rate, and review this podcast and all the other University of Kentucky Healthcare podcasts. I'm Melanie Cole.
Hepatitis C Care at UK HealthCare
Introduction: Another informational resource from UK healthcare. This is UK HealthCast, featuring conversations with our physicians and other healthcare providers. Here's Melanie Cole.
Melanie Cole: Welcome to UK HealthCast with the University of Kentucky Healthcare. I'm Melanie Cole, and today we're talking about hepatitis C and treatment options available at UK Healthcare. Joining me is Dr. Jen Rosenau. He's a Gastroenterologist in Digestive Diseases and Nutrition at UK Healthcare. Dr. Rosenau, it's a pleasure to have you join us today for the listeners. Can you please start by explaining what is hepatitis and telling us a little bit about the different types that we've heard about?
Dr. Rosenau: Hepatitis is inflammation of the liver. And there are different types of hepatitis viral, hepatitis C is one of those viral infections that can cause hepatitis, hepatitis B virus can cause hepatitis. And there are other forms of hepatitis, for example, autoimmune hepatitis, where your own immune system can attack the liver. There's alcoholic hepatitis, there's hepatitis from nonalcoholic fatty liver disease. So there are many different types of hepatitis, but as I understand, we will talk about hepatitis C today.
Host: Yes, we absolutely will. So give us a little brief overview of Hep C specifically and tell us the difference between chronic hepatitis C and acute?
Dr. Rosenau: Yeah, hepatitis C. If a patient gets infected with hepatitis C, many of the patients go through an acute phase in the very beginning of the disease. Sometimes this acute phase can be unnoticed. Sometimes there are symptoms associated with it. This acute phase, there can be symptoms that are unspecific, just like nausea, vomiting, abdominal pain, very unspecific symptoms. Sometimes patients become jaundice, they turn yellow. So it's a little bit more obvious, but many patients really never have symptoms. If the immune system does not eliminate the hepatitis in this acute phase, it can become chronic, and chronic hepatitis C is then typically not associated with any symptoms. It's usually completely asymptomatic, but the problem is that it can cause liver damage over time, which usually takes a long time. But there are some factors that can accelerate the course and the hepatitis can damage the liver.
Host: Well, then tell us who is at risk for hepatitis C and is it more prevalent in one race than another? Tell us the risk factors and who really needs to think about this?
Dr. Rosenau: Yeah. And there are multiple risk factors. It's easiest to keep in mind that hepatitis C is mostly transmitted through blood contact in some way. And what we see most of the time, these days is injection drug use as a cause for hepatitis C. So injection drug share, drug share needles sometimes with others. And then there is blood contact and the hepatitis C virus gets transmitted that way. I would say that it's definitely the most common cause of transmission these days. There were many other ways of transmission in the past, like blood transfusions or for example, hemodialysis, or there were smaller groups of patients who got infected in different ways. Nowadays really lot gets screened very well. And this transmission risk is minimized. There are other ways of transmission, for example, tattoos, especially tattoos in an unregulated setting where the equipment is not sterilized in an appropriate way. I've heard from some patients that can even happen in the regular life setting. But that is rare. I would say those are the most common ways of transmission. You may have heard that hepatitis C can also be sexually transmitted. That is actually rare, at least in heterosexual, I would say heterosexual contact. It's very unlikely to exceed hepatitis C that way, but men who have sex with men have a higher risk of transmission.
Host: So, then Dr. Rosenau how is it diagnosed? Is there a screening? And if so, who should get tested?
Dr. Rosenau: There's a screening test available and it's a very, very simple, most of the time a blood test that is used, or there are other tests coming up now. There is now a recommendation that everybody should get tested. So really anybody can ask the doctor, can I please be tested for hepatitis C. Once in a lifetime at least, these specific recommendations of just testing the at risk population were not very effective because doctors have a lot of things on their mind. States do not always think of hepatitis C. So they quite often really forget to ask these questions and go through these things with every single patient. Then eventually a recommendation came out that all baby boomers should be tested because we knew that the hepatitis C that's more prevalent in baby boomers. So people born between 1945 and 1965. And for some time that was the simplified recommendation. But then we have noticed in the last decade that a lot of younger people got infected and it has a lot to do with this epidemic of drug use, especially here in Kentucky. Now, finally, we have the recommendation that anybody irrespective of age or risk factors, can get tested.
Host: So, tell us a little bit about treatment options at UK Healthcare and how the University of Kentucky Healthcare has really taken the lead in getting people tested and treated in Kentucky?
Dr. Rosenau: The good news is we have very good treatment options available these days. So within the last probably five, six years, we got a lot of very good options, very effective options, so we can cure almost everybody now. And it's not only that these treatments are very effective with almost a hundred percent cure rate. These treatments also are very well tolerated. There are very few side effects with these new treatments and the treatment is short. So it just needs about eight to 12 weeks. And it's just pills. There are no more injections. So we used to have interferon, which needed to be injected. Interferon had a lot of side effects. Interferon did not work very well. So this is all history fortunately, now we have these highly effective options that are well tolerated and with very short courses and just pills that you have to take.
Host: Wow, isn't that amazing? So, as you're speaking about how treatment is easier for the patient than it was maybe 20 years ago, is this more cost effective for the patient and are more insurance companies now paying for treatment?
Dr. Rosenau: Well, interestingly, when these new treatments came out, they were expensive. They were more expensive than previous treatment we had. But if you calculate that the cure rates were also very high, the price was actually about the same, but since we had a surge in hepatitis C with more patients coming in and more patients interested in treatment, the cost became pretty high for the healthcare system. So there were many restrictions in place from insurances in the first year, so 2014, 2015, when these drugs came out. Prices have dropped since then. It has been shown very well that the treatment is very, very cost effective. It's actually even cost saving. So treating patients, saves in the long run, because if we don't treat, we may eventually get complications of liver disease. And that is far more expensive than treating at the very beginning. So insurances have now mostly removed their restrictions at least here in Kentucky. And that's very good news. So even Medicaid approved treatment, most of the time. As one little caveat, we still have problems, retreating patients. So we can treat the first time. But if patients get reinfected, it may be more difficult to get the treatment reapproved for a second course.
Host: Well then before we wrap up and it's just such an interesting topic Dr. Rosenau, can it be cured? And then you'd mentioned re-infection, can it be cured? And as you're saying that, can you tell us how we can reduce our risk of getting hepatitis C and what you want listeners to know about the care available and testing available at the University of Kentucky Healthcare?
Dr. Rosenau: Absolutely. The hepatitis C can be cured and we can cure almost every patient who comes into our doors now. And I have mentioned that these treatments are very well tolerated, shot treatment typically does get approved. Come to see us. We have an interdisciplinary team at the University of Kentucky, where treatment is driven by pharmacists. You will see a provider in our clinic who will discuss hepatitis C with you. We will find out how you got infected, when you got infected. We'll educate you about the possible course of hepatitis C, if it is not treated, we will discuss treatments. We will discuss drug interactions, potential side effects, all these things with you. So definitely if you were diagnosed with hepatitis C, come and see us. Risk reduction to not get reinfected is incredibly important, since treatments are expensive and the insurance may not approve re-treatment. So the most important thing is probably to engage in a drug rehab program. If you continue to use drugs for any reason, or if you slip and relapse and start using drugs again, the most important thing is really to do it in a safe way to prevent reinfection. So not sharing needles, not sharing equipment, getting tattoos in a regulated setting. Those are the most important things to prevent the hepatitis C comes back again. You cannot reinfect yourself. So it's a transmitted disease. So it needs somebody who transmits the disease. And most of the time that's sharing off equipment with drug use. If you avoid that, you should not get reinfected
Host: Such important information. Doctor, thank you so much for joining us today and sharing your expertise. This is such an important topic. And that concludes another episode of UK HealthCast with the University of Kentucky Healthcare. For more information on hepatitis C and the treatment options available, please visit our website at ukhealthcare.uky.edu, and look up digestive health program, hepatitis C. Please remember to subscribe, rate, and review this podcast and all the other University of Kentucky Healthcare podcasts. I'm Melanie Cole.