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Hepatitis C and The VA 030517

Feb 28, 2017|

AN INTERVIEW WITH DR. MICHAEL CHANG WITH THE PORTLAND VA HOSPITAL AND DANA SMOTHERS, A HEPATITIS NURSE WITH THE VA, ABOUT HEPATITIS C, TREATMENT, AND HOW VETERANS CAN GET TESTED AND TREATED.

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Automatically Generated Transcript (may not be 100% accurate)

This is microscope and Entercom radio Portland public affairs program and during blocks all. The Department of Veterans Affairs leads the country and hepatitis screening and testing and treatment research and prevention. And we're gonna dive into that on the show this time specifically hepatitis C. I like to welcome to the program doctor Michael Chang and the chief of gastroenterology and haven't elegy add VA Portland health care system and an associate professor of medicine at Oregon health and science university. And also do you smothers hepatitis nurse with MBA welcome to microscope. Throw out touch slowly so darker saying let's start with you we're going to be talking about hepatitis C today he explained to us what is hepatitis C. That they see is a viral infection. There is passed through blood contact. And it's a virus that replicate content for chop liver and after a prolonged period of time usually measured in decades. Anywhere from twenty to forty years. They see can result and not sensational or disease. Is there a difference between Pepsi pep A and have me. Yes absolutely these it's potentially apples and oranges. Hepatitis is a term that simply were. Refers to inflammation in the liver. We need designation. Eight BC refers to lose an entirely different viruses which different modes of transmission. Different. Severity assessment so. Yes they're very very different entities completely. How is Pepsi contracted. Let's see isn't there is passed through blood blood transmission. It's true you can't. Acquire had achieved by kissing the holding hands high gain. Mean most common form of acquisition is through IV drug use according to the CDC. Buy it. If other little way to acquire include. Now Maytag few using dirty needles. Story of naval cocaine and sharing straws because that does lead to nose bleeds and transmit them. Possible transition of blood. One interesting area where it is very rare to pass citizen. Strong we have asked sexually transmitted disease. To compare that to say the B which is. Or agency. Again it's. Sleep through blood transmissions. When they didn't shoot you know less so it through just physical contacts. That's inducing about these snorting aspect of drugs I never thought of that before. Yeah it's in and I came up through epidemiological. Are you looking at mode and acquisitions it is certainly unique in that sometimes oftentimes not not a way of acquiring these infections. Those who should be tested for hepatitis C and how that has done. So is this very simple blood test. And so BL eighteen. Billy get your blood tested to just requires that in order showing a pullout. As far as who should get this done the CDC. Came in the US task force came out last year actually a year and a half BL. Stating that anybody born in the BC boomer cohort those folks were born between 1945. To 1965. Or. I translation or between 51 to 71 years so low wage at this point. Have at least one time testing for hepatitis C. The rationale behind that is that this specific birth cohort has several fold increased risk for having had seen. And again that's C ism it is acquired through blood contact. And that reflects in part of that area in the 1970s and eighties plant in addition to the fact that hepatitis C has an inspection. Was not fully characterize or diagnose the ball till about 1991. Prior to 1991 that there was not even a blood test just to test perhaps he was called non a non B viral hepatitis. Conserve because the lack of recognition of this conditions. And like a tool to diagnosis. Really well kind of flew under the radar for quite a long period of time. Until now says you ask them is a simple blood test its an antibody blood tests identify his. And the president of the footprints. The virus in the body it's immune response to the virus. In this being antibody test comes back positive. Then we move on to confirmatory tests he called me up PCR polymerase chain reaction. Default under this sort of broad category of call the new quick ascent past where we actually look further viral RNA in the in the blood. How long after exposure and that dude do you test positive is it is an immediate or does that take some time. No it takes some time you know take some time for the immune system to generator response perform these antibodies could traditionally you know we will insurgency presence of antibodies in the blood for 3060 days after exposure so it's good it's not a wrap it around so it's only catching a cold. It does take some time for the virus to make itself known. What are some of the symptoms of hepatitis C would you know immediately. Thankfully none thank you haven't played either reason why you you know there's a strong public health push now task to poke. And in the baby boomer core worry because it is because. Generally it's stated is that roughly asymptomatic condition. Even at the time and acquisitions. The most common types of symptoms are flu like illness and so the symptoms do not persists. For very long in the oftentimes it's body aches me alone great fear of the general sense of not feeling well. Then you know most people to shrug off and then you can you know their lives. And so there's an estimate that 50% of people who have had to see are undiagnosed at this point in their against speak to the fact though after acquisition. Miles section itself is mostly symptomatic and lies lies. You know and this causes damage are very quietly. How many people do you suppose. Have the infection. So in the United States is estimated to be about 1% or so of the population so it's somewhere in order allowed three million. Hiring Asia during halftime four million. The US. Americans are infected with hepatitis C. And of that 1% of the population how many people are unaware that they. Have hepatitis C. Don't get the flu around 50%. There's a large proportion of people who have had to be out there we just don't know about drugs while it's still number. It is and I think it speaks to the whole public health movement now recognizing that this condition can be easily cured. And treatment is. Very effective that he understood that very different paradigm. Compared to you know just even five years ago where the treatments were were terrible. That's just picked up straight for pour. And so people war it's you know there was going to be pushed to test because of good lose their. Sure. Absolutely so. You know. And from 2000 to about ten or eleven the mainstay of tree villas this drug called I deleted interferon. Man that was what we are forget the bad old days because. Drugs average duration of therapy that 48 weeks it's almost a full year. They cure rates soar only in the 40% range and the V medications felt a terrible side effects for the entire duration therapy. And so to convince somebody thing teachers with the treatment where in the relatively poor outcome little outside effects because usually a losing battle to. And through since going eleven being a Tony twelve really. We started seeing new driver into the market to a tree you have to see it. In the teeth straight at that point one allow we're collapse earlier both suffered here. And an entire when he twelve wesun need drag it to the market call for Foster parent and really at that point that we start to see the first interference free regiment arrived that was around 2013. And these new interference free regiments. They have shortened duration from 48 weeks down because short is eight weeks although the majority of therapies are all weeklong. The treatment is no longer injection done three times a week which is what we abuse can do for an affair I know it's a but once a day tablet form in many cases. And the curious have gone from 40% served right around 95%. Doing one still want to date for twelve weeks it's really been a complete revolution in the field of hepatitis C. And that's improved pretty remarkable. Pretty remarkable work. He had no idea at this point yeah I think. Uranium big pharma often gets a bad rap but in this area the research that has gone into creating new cures threats he is really does a completely changed the faith how we be treatment. What our expectations are for the treatment. We're talking today was doctor Michael Chang the chief of gastroenterology and capital G at the VA Portland health care system. The doctors tell us how many veterans and Oregon and southwest Washington can of Pepsi. So do very roughly eight again at this point we've. We treated her offer treatment to well over half of veterans and our catcher and by going back 220 to well the numbers that we're looking around 6800 veterans. That's how. Why that population. To act you know it turns out that the prevalence of perhaps he would hire veterans compared to civilians and so you know we've talked about the baby boomer court. Both veterans. Are a very special populations. And they also looked at him for that cohort they live there a time where there are lots of stress and lots of exposure risks. Mention those the prevalence of Pepsi mountain veterans particularly veterans have borne that BB Merkel worth somewhere between five to 10%. It's no overall prevalence based on display the done by doctor dominance up at the Seattle VA showed. Then it around 2004 that was around five point 4%. That's all comers you look at the burden from birth cohorts have turned up at that prevalence of much higher amongst baby boomers. So. It's you know. That it certainly is striking fact been one that we wanna make sure that you know veterans are aware of and that you know that's the message to get tested is heard loud and clear. We're also speaking today when do you smothers the hepatitis nurse with the NBA. But didn't tell me about your experience with hepatitis C. Well my role in this campaign is to reach out to the veterans you know we're and then southwest Washington. To let them know that this testing and treatment is available. And how to access that. And if you really follow them through the process to make sure at this successful completion. What is the BL reaching the veterans now. Well the VA is absolutely committed to offering the testing and treatment to look at trend. And right now given the funding that has been that I'm provided. And the exceptional cheers that are available the treatment options we have really geared up our clinics to be able to. Maximize that synergy and really really. Provide that timing opportunity for veterans to get. Testing get the care and get this behind them. What's the best way for veterans who have to get tested and find out well this information. Absolutely am so glad you and as we have set up a best that they caught my name and and an extension here at the VA in fact it is on my desk. And they're a veteran Kenny streamlined call me directly. Accessing our team. And we will return their call with information. You know every veteran has a different story and then is in a different place with primary care provider or not. Recently moved to the area. You know a multitude of things but that's what we're here for if they help them. Meet them where they're at and walks into the process of accessing the treatment that's that's the goal. What does the constant. Don't go ahead I'm sorry oh I was just give me the number OK. Let you read my mind could affect. That number is 1809. Or denying. 1004. And that's the main VA number. If anyone remembers anything at the expansion and that is 534. 71. Is there a website where people can get more information as well. There is that is not the Portland to. The DA web sites there's also a FaceBook page. That they can access that information as well. What would you say to a veteran who's listening now about coming in and and having that test done if there may be feeling a little apprehensive about it. Oh what a great question and that happens all the time we speak to veterans every single day. Well with that very feeling in mind. I would say. Disregard or put aside aid needy what you hadn't understood about hepatitis B treatment in the past. And you need that you had had all these many years possibly. That this really is the best time. I had to achieve this cheer and do this for yourself and then. Many cases for your grandchild or for a for a loved one or Ford you know you have served. My guess Blake you and you know we can serve yield and help you reach this chair. Do you find that. Big people in general navy veterans in particular how some shame around us. We health. Shame. Possibly some misunderstanding. You know often spoke full they believed to be very complicated or it's very. You know come burst some. The process. I would absolutely. Let them know that. One tablet that day we hear you know morning vitamin. Super super simple. And you know it's so effective in so expect it to cheer. This. There's a lot of uncertainty in in medical care but boy this is an absolute almost a 100% here. And that's the doctors said earlier you know live in the past the treatment wasn't extraordinarily complicated and sometimes worse than having lived in the disease itself. And now it's a very much simplified. Very simple and you know some people would say that VA system and navigating that can be. Difficult and challenging as well we have really really. Put forth in a tremendous efforts to me. Contacting us and saying I am ready to do this or want more information on meth. So very very simple and the arts surrounded by a team of professionals that I'm will be. Walking within the entire process. And I am so trying to trying to make it very very simple they don't need. They have a doctor's appointments and I'm with their primary care provider in order to access they can call left directly. So Dana let me ask you for veteran name maybe isn't sure if they're eligible for VA care for Pepsi yeah. And how they find that information elegant. Well just by calling I. And we can direct them. And there are again part of our. Team are they experts with the enrollment and and all of that eligibility. That is that meat but I know how you. Helped in view that's an access that information. And how confidential is the so they can often talked to a bunch of different people born before they get to the right person may be having to explain their situation. And no I'm understanding me ask this sensitivity. This issue and in you know that's part of the education as well. And the come to eat local person. Myself. At our center. They lead a confidential voicemail with their information. And every. Step along the way it's handled and a professional. And confidential manner absolutely. To you that phone number one more time. How would think you France gain with the fact that it's 1809491004. And the expansion is buying degrees for 71. And before you to the end of the show all I ask you the phone number one we're going to keep it handy okay do you. The doctor saying it could you explain to us maybe some of the lone long term effects of hepatitis C if it goes unchecked. And who it is turned we look at burns more we call natural history this condition not every one with hepatitis C will wonderful liver failure or die from the condition it turns out it's actually just a minority of people. But it's. You don't if we took a hundred people lined them up and all the met hepatitis C. Over that when he gets thirty year time period of about 25%. To one and four other risk of developing cirrhosis. Now throw a little slow and a lot of times people have a misconception of what this condition is. Truth is simply refers to the fact that they're that advanced scarring and deliver them that's scarring of the curve that's when he is 3030 year period. As their immune system has struggled with the virus and in the meantime deliver tissues if he gets injured an instance scar tissue gets bogged down in its place. When we talk about throws it's simply a reference to the severity of scarring of the the liver. I have been through this has consequences than those consequences include the potential to progressed to liver failure as well as develop liver cancer. It's turned out throws this is the single biggest risk factor for the development of liver cancer. And if we recognize the condition we can screen for liver cancer and serve veterans or any station that stress incidents and screening program to detect liver cancer early. And I don't want the fact is that we have good interactions for liver cancer again if if we can catch it early. Through. 5% to 30% of the folks over twenty to thirty years can develop. Significant liver disease. You know the folks were looking. We're more looking to prevent that progression. So and so. You know we wanna treat everybody because we can't predict given at length of that horizons who's going to develop liver these either or not. And with such an effective. Treatment with such a few side effects. From a population health standpoint it just makes good sense to treat everybody in eradicate those conditions. Could you briefly explain to us the function of the liver in the money I'm assuming it's pretty important organ. There's an at. And it's you know has an amazing thing is that half of what it does this still mystery. DL we we talk about the liver. Is he me an Oreo which queen your blood and it does play action Mattel more either breaks down over 80% of all medications that we take and all the food and nutrition that comes into our bodies delivered the first way station were all those those nutrients to. Especially broken down and re process of our bodies can use it. On top of that pillar of the responsible for making that you know hundreds and thousands of proteins for our bodies just simply for bodies to a function. I live also plays a key role in the immune system because it turned out about half of our innate immune system make sure that I deliver. That's to protect doesn't scream and yell all that's nutrients amino thing that we just also will have you know oftentimes some actuarial products and there. Delivers responsible her helping them process our response to that so. There's a synthetic component to it there's been I mean component to it and then there is a essentially processing are cleaning component to that. Is it possible to have hepatitis C and not have any. Adverse effects. Absolutely and so there again near the vast majority of people who have had seen when we finally when we make that diagnosis really have never been aware of its. I'll spend than they look back they'll say well you know I have been all the more tired than you know that I should be. They turned around on average most people have teachers don't have demonstrable symptoms and so the best way to really find out if you have is to get tested. And let's talking an about the population of of the United States that should be tested for hepatitis C. Again though the focus right now is to really reach out to folks were born between them 1945 to 1965. Time periods against talks between and they just 51. To 71. And then the other. Part say didn't emphasize that anybody who has the risk factors begin we talked about who does the main risk of transmission exposures to the blood so anybody at high risk behavior. Anybody is that you recreational drag. You. Receiving nephews you know anything from an unprofessional parlor. I know their folks to actually should be Pestrana more frequent basis not just one time testing. But as far as general population health goes it's their baby boomer cord were we're we're sending this message to. And how about veterans. That some food cart their particular veterans in particular there but I'm more risk. Dude it's turned out that baby boom we're all worried applies also for better in the bud says in many VA's across the country we are offering testing for everybody walking through the door to the Portland VA we generally sound. Are offering Pepsi testing to anybody interest and it's. Words specifically. Focusing in unlike some of all the aspects making sure that we're targeting our. Highest risk group which is the baby boomer cohort. It's really than anybody who has increased risk factors. There are also target and then they actually have what we call clinical reminders embedded. In their medical records to help. Remind our clinicians to do that testing and regular basis. And as you said earlier some relatively simple test and actually a pretty simple treatment. Absolutely it has since it's a simple blood test. I'm in the blood tests and. The accuracy of their passes or 99.9 percent accurate. And on top of them wanted testing is done if we come back positive we reflex that didn't even more sensitive stuff that's now or PCR testing. Which is almost. My 100% effective in in terms of making a diagnosis. And Dana as promised for entrance into the show I wanna bring you back in in and how you give us all the information on how veteran can get more information and get tested. Absolutely and I would follow up what Doctor King just said. If someone maybe with tested many many years ago or doesn't know if they've ever been tested. Or they do know they're positive for hepatitis C any and all. That's. Options please feel free to call this telephone number. And you will be I'm receiving a call back. And we can block unit triage and you excuse set up the testing you need. Educator around the processed. And go forward together so that number. Is at 1800. Nine born and I aimed. 1004. In the extension at 53471. Excellent. We've been talking today with doctor Michael Chang the chief of gastroenterology and capital GM BA Portland health care system and then associate professor of medicine in Oregon health and science university. Ending the smothers the hepatitis nurse also with the NBA thanks ergonomics scope. Mitchell's bill is an Entercom radio Portland public affairs program I'm Gary blocks of if you're involved with the nonprofit or public affairs organization or do you have an idea for an upcoming show I'd like to hear from you. Visit microscope PDX dot com and submit your ideas you can also go to the station's website handsome richer information there. Thanks for listening Demitra scope and enjoy the rest of your weekend.