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Hepatitis C Virus & Impact on US Veterans

Caroline Park

AbbVie Medical Affairs

Hepatitis C virus (HCV) is a contagious disease

Hepatitis C is a contagious liver disease caused by a

virus

Centers for Disease Control and Prevention. Hepatitis C FAQs for the Public. Updated October 2016. Available at: https://www.cdc.gov/hepatitis/hcv/cfaq.htm. Accessed February 2017.

In 85% of cases, it leads to a serious, lifelong illness that attacks the liver

Upon infection, some have mild illness lasting a few weeks

HCV is spread primarily through contact with the

blood of an infected person

Half of People With HCV Are Unaware They Are Infected1

• 2.7–3.9 M infected individuals in the US2

• There are 6 HCV genotypes, most are infected with genotype 1 (75%)3

1. El-Serag HB et al. Gastroenterology 2012;142:1264-1273.e1; 2. Centers for Disease Control and Prevention. Hepatitis C Information for Health Professionals. Available at: http://www.cdc.gov/hepatitis/HCV/index.htm. Accessed February 2017;3. Messina JP, et al. Hepatology 2015; 61:77‒87.

DON’T KNOW HCV+

STATUS

HCV Infection is Higher Among US Veterans

1. U.S. Department of Veterans Affairs. Hepatitis C infographic. Available at: http://www.hepatitis.va.gov/pdf/hepatitisC-infographic.pdf. Accessed February 2017; 2. Beste LA, Ioannou GN. Epidemiol Rev 2015;37:131–43; 3. Stars and Stripes, Sept 16, 2016. Available at: http://www.stripes.com/news/va-estimates-107-000-vets-have-undiagnosed-or-untreated-hepatitis-c-1.427437. Accessed February 2017.

87,000 remain untreated & an additional 20,000 are undiagnosed

• 4–17% of US Veterans may have HCV infection1

• Most were born between 1945 and 1965, also known as “baby boomers”2

• 65,000 veterans have been treated3

• The CDC recommends one-time HCV screening for all baby boomers2

• But at least 700,000 have not been screened for HCV3

How Does HCV Affect the Liver?

• Chronic HCV is a leading cause of liver transplantation and liver cancer

WHO Guidelines for the screening, care and treatment of persons with chronic hepatitis C infection. April 2016. Available at:http://apps.who.int/iris/bitstream/10665/205035/1/9789241549615_eng.pdf Accessed February 2017; Thein HH, et al. Hepatology 2008;48:418–31; Howlader N, et al. SEER Cancer Statistics Review, 1975-2010, National Cancer Institute. Bethesda, MD, based on November 2012 SEER data submission, posted to the SEER web site, April 2013; Ghany MG, et al. Hepatology 2009;49:1335–74.

HCV InfectionOccurs

ChronicHCV

Infection(75–85%)

Mild Liver

Scarring(Fibrosis)

Moderate to Severe

Liver Scarring

15–30%Extensive

Liver Scarring(Cirrhosis)

Liver transplant

or early death

Decompensatedcirrhosis (4%)

Liver Cancer (1–2%)

~20 years

HCV Can Impact Other Parts of the Body

Cacoub P, et al. Dig Liver Dis 2014;46:S165–73.

Blood

Skin & Kidney

Metabolic

Kidney

Heart

Neurologic/psychiatric

Muscles & Bone

SkinEyeHCVLiver

16

8

41 40

29

39

14 13

0

5

10

15

20

25

30

35

40

45

50

HCV is the Leading Cause of Death from Long-Term Liver Disease in the US

HBV, hepatitis B virus. *Based of the Global Burden of Disease study 2010. Cowie B. and MacLachlan J. AASLD 2013. Available at: http://www.natap.org/2013/AASLD/AASLD_38.htm. Accessed February 2017.

HBV HCV

Alcohol Other

Liver cancer Cirrhosis

Pat

ien

ts (

%)

HCV is thought to be responsible for ~40% of liver cancer/cirrhosis deaths in the US*

HCV Can Be Cured

• Cure rates for chronic HCV have risen in the era of direct-acting antiviral therapy

• The goal of HCV treatment is to reduce death and significant liver-related problems1

• Based on available 10-year data, curing HCV is associated with lower complications & death2

1. AASLD Guidelines. http://hcvguidelines.org/full-report/when-and-whom-initiate-hcv-therapy; 2. van der Meer AJ, et al. JAMA 2012;308:2584–93.

1991 2001 2011 2013 2016

16%

44%

70%

90%95%

Benefits of Treating Early & Curing HCV

1. McCombs J, et al. JAMA Intern Med 2014;174:204–12; 2. Marinho RT, et al. J Gastrointestin Liver Dis 2014;23:85‒90.

Decreases liver complications and death1

No risk of HCV transmission to others2

Improves non-liver complications

May increase quality of life & psychological impact

Summary

• Up to 3.9 million people in the US have chronic HCV

• Most are unaware of their status

• US Veterans have a higher rate of HCV infection

• 700,000 US Veterans in VA care need to be screened

• HCV contributes to long-term liver damage and liver-related death more than alcohol use

• Early treatment improves liver and non-liver-related complications and survival

How Can We Help US Veterans?

1

2

3

Recognize that US Veterans have higher rates of HCV infection

Help connect them with the VA where they can be treated

Encourage them to visit the VA for a

simple HCV blood test