Chronic Hepatitis C: Background, Epidemiology and Clinical Features of the Population

Hepatitis C virus is the most common bloodborne pathogen, affecting more than 170 million people worldwide. Chronic infection with hepatitis C is typically characterized by a long latency after which the sequelae of end-stage liver disease, including hepatocellular carcinoma and decompensated cirrhosis, contribute significant morbidity and mortality to the disease course. Approximately 75% of the chronically infected population in the United States was born between 1945 and 1965. While incidence of hepatitis C has been decreasing, progression to end-stage liver disease by the chronically infected population is expected to increase over the coming 10-20 years. Psychiatric co-morbidity and substance use are common in individuals with chronic hepatitis C infection. With the advent of more effective and better tolerated treatments for chronic hepatitis C, care providers have new opportunities to help avoid end-stage liver disease and liver cancer in this aging patient population. However, the same psychiatric issues that are common in the population may predispose individuals with hepatitis C not to initiate treatment or to nonadherence once on treatment, thus representing barriers to successful treatment outcomes. We adapted elements of supportive individual and group counseling, telephone consultation, and team consultation with structure designed to treat patients with psychiatric disorders. We used Fonagy’s work on adopting an inquisitive, flexible stance rather than an expert role vis a vis our patients. Our team, which consists of a nurse practitioner, a social worker, and a patient navigator/care coordinator, has been able to successfully guide co-morbid individuals through chronic hepatitis C treatment and treatment complications.