Case Approach to Improving Virologic Response, Early and Sustained

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Statement of Needs

Hepatitis C virus (HCV) infection places a significant burden on the individual and the US health care system. The standard of care for patients with HCV infection consists of pegylated interferon (peg-IFN) and ribavirin (RBV), with the goal of achieving a sustained virologic response (SVR). Maximizing response to therapy is particularly important in treatment-naïve patients, and can be achieved by tailoring the duration and dosing of therapy based on pretreatment risk factors, on-treatment viral responses, and adverse events. Ensuring adherence is also critical to treatment success. Overall, initial treatment with peg-IFN and RBV is only effective in approximately 50% of patients. Maximizing retreatment efficacy requires a detailed evaluation of the treatment history of nonresponders/relapsers to identify correctable factors, since currently available therapeutic modalities for retreatment are limited when no correctable factors can be identified. Fortunately, novel agents in various stages of development are under investigation.

Whereas current treatment with peg-IFN and RBV is not associated with specific viral resistance, the use of targeted antiviral therapies raises the issue of emerging drug-resistant viral variants. In the near future, treatment of HCV infection may consist of a backbone of peg-IFN and RBV, administered in conjunction with either a protease inhibitor or polymerase inhibitor, and further down the line, the use of a combination of multiple specifically targeted antiviral therapy.

A significant number of patients with chronic HCV will progress to cirrhosis; and HCV-associated cirrhosis is the leading indication for liver transplantation. SVR has been shown to be associated with improved clinical outcomes and histologic benefits in patients with advanced liver disease. Health care providers who treat patients with HCV with advanced fibrosis/cirrhosis should be aware of the increased morbidity and mortality. They should carefully weigh benefits vs risks of antiviral therapy, closely monitor patients for signs of hepatic decompensation, and recognize when to refer patients to more experienced clinicians.



	The CARES program offers Breakfast, Lunch and Dinner Meetings at sites around the country. Each meeting will cover 1 case study and last approximately 1 hour.



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Since HCV and HIV infection share similar modes of transmission and risk factors, it is not surprising that approximately 30% of patients who are HIV-positive are coinfected with HCV. Whereas HIV affects HCV disease progression, it is unclear whether HCV affects HIV progression. Knowledge of the many potential drug-drug interactions and drug-induced toxicities that can occur between highly active antiretroviral therapy and anti-HCV drugs is necessary in order to avoid potential dose-limiting complications that may compromise adherence and therefore SVR.

Chronic hepatitis B virus infection is also a major public health problem in the United States. The goal of antiviral therapy is to prevent disease progression and its associated complications by achieving a sustained virologic suppression without developing viral resistance. Whereas the indication for treatment initiation or deferral may be straightforward in some cases, all patients with chronic HBV may be candidates for treatment at some time, underscoring the need for individualized treatment decisions and diligent patient follow-up.

Health care providers in this rapidly evolving field need to stay abreast of the latest developments in order to optimize patient outcome. The CARES 2009 initiative has been designed to meet the educational needs of both experienced health care providers and new treaters in the field. Eight case-based educational presentations have been developed for this initiative.

Case Studies
1. Treatment-Naive Patient With HCV Infection: Improving the Odds of Achieving a Sustained Virologic Response
2. Nonresponder/Relapser With HCV Infection: Optimizing Current Therapeutic Modalities
3. Patient With HCV Infection: Exploring Future Therapeutic Modalities
4. Patient With HCV Infection and Advanced Liver Disease: Assessing the Impact on Treatment Decisions
5. Patient With HCV/HIV Coinfection: Rising to the Challenge
6. Patient With HBV Infection: When to Treat and How to Treat

Developed for New Treaters of HCV
7. Newly Diagnosed Patient With HCV Genotype 1: Initializing Treatment
Developed for New Treaters of HCV
8. Patient With HCV: Managing Side Effects of Antiviral Therapy

Audience

This program is a continuing education initiative designed to meet the educational needs of hepatologists, gastroenterologists, infectious disease specialists, nurse practitioners, physician assistants, and other health care professionals involved in the diagnosis and active management of HCV.

Accreditation Statement

SCEPTER is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide CME for physicians.

Policy on Disclosure and Disclosure Information

SCEPTER adheres to the ACCME Essential Areas and Policies, including the Standards for Commercial Support, regarding industry support of CME. Disclosure information is provided during the planning process to ensure resolution of any identified conflicts. Disclosure of faculty and commercial relationships, as well as the discussion of unlabeled or unapproved use of any drug, device, or procedure by the faculty, will be disclosed to learners. .