More than 3.5 million Americans have chronic hepatitis C (HCV), but many live with the disease unaware that they are infected. People can live for decades without symptoms. Since approximately 75 percent of those infected with HCV were born from 1945-1965, the CDC recommends that everyone born during this time, often called baby boomers, get tested for hepatitis C.
A diagnosis of hepatitis should always be taken seriously. Chronic, untreated hepatitis can lead to cirrhosis, liver cancer or death. The "Lourdes Hepatitis C Clinic" is dedicated to the comprehensive evaluation, diagnosis and treatment for patients with all phases of hepatitis C infection.
In this segment, Hisham ElGenaidi, M.D., Associate Director of Transplant Hepatology, explains how they evaluate, treat medically and, where appropriate, list patients with severe cirrhosis for liver transplant, and how the staff provides education and compassionate support, as the treatment for hepatitis C can be rigorous.
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Lourdes New Hepatitis C Clinic
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Learn more about Dr. Hisham ElGenaidi
Hisham ElGenaidi, MD
Dr. Hisham ElGenaidi is a Liver Disease Specialist with Lourdes Medical Associates.Learn more about Dr. Hisham ElGenaidi
Transcription:
Melanie Cole (Host): More than 3 ½ million Americans have chronic Hepatitis C, but many live with the disease unaware that they are infected. The "Lourdes Hepatitis C Clinic" is dedicated to the comprehensive evaluation, diagnosis and treatment for patients with all phases of hepatitis C infection. My guest today is Dr. Hisham ElGenaidi. He’s the medical director of transplant hepatology at Lourdes Health System. Welcome to the show, Dr. ElGenaidi. Tell us, what is Hepatitis C?
Dr. Hisham ElGenaidi (Guest): Well, Hepatitis C is a virus that’s transmitted blood-to-blood and what I mean to say by that is people who have used IV drug abuse in the past or people who were transfused any blood products prior to 1992, these are the general methods of how the virus is transmitted and Hepatitis C actually affects not just the liver, but it has other effects as well. It can change insulin resistance so, therefore, predisposing people to diabetes. It has some immunological changes that can happen as well, things like myoglobinuria, which can affect the kidneys and cause kidney disease. It can cause vasculitis. It has a multitude of other harms that it can do to the body, and this is why it’s so important to get screened and treated for this infection.
Melanie: So give us some stats. Tell us who should be screened and we hear baby boomers are at risk for this, tell us why?
Dr. ElGenaidi: Well, the transmission rates that occurred mostly in the 1960s and 1970s were very high. These people have all now aged, and they are in the baby boomer population. That’s anyone born between 1945 and 1965. They found that if they screened only for those that are at risk, they didn’t get a big enough bang for the buck, in other words, we weren’t catching enough Hepatitis C infections, but in the baby boomer population, we see that 1 in 30 actually does have Hepatitis C regardless of the risk factors.
So the CDC put out a notice several years ago, as well as several other societies, like the American Association of Liver Disease. This is now what we’re trying to do is get the word out, try to screen everyone that falls in that population and get them treated because over time – over many years – they were infected in the 1970s and so on. Some of these people have already developed liver cirrhosis. With liver cirrhosis, these patients can have liver failure and decompensate and require liver transplants. They can also develop liver cancer, and they may also have many of all the extrahepatic manifestations that I mentioned earlier, so it’s important that we try to get these patients in now and treat them.
Melanie: So before we talk about that screening, Dr. ElGenaidi, speak a little bit more about transmission and exposure and the way that it’s spread because, of course, some baby boomers maybe got tattoos, or they're concerned about sexual contact that they had when they were younger, or if somebody in the family has it. Speak about additional methods of transmission.
Dr. ElGenaidi: Right, so we mentioned IV drug abuse, but also the intranasal use of drugs such as cocaine snorting – the fact that they share the straw, they can actually pass it along from one person to the next. You mentioned already tattoos and piercings. Some people have gotten these tattoos many years ago prior to instituting sterile techniques, so it’s not just the needle where you can get the transmission, but it’s also the ink itself. The virus can live several days in the ink. It’s important that if people go to get tattoos that they see what’s going on, that it’s a legitimate tattoo parlor, that they’re using new ink, new needles, so that’s how to prevent that.
But other ways, sexual transmission, it can happen, but it’s not so common. We generally say transmission of approximately 10% over a 20-year period in a monogamous relationship. Obviously, if patients have other forms of sexually transmitted diseases, such as example, HIV, 30% of anyone with HIV does have Hepatitis, so it’s the same mode of transmission.
Other forms, believe it or not, is hemodialysis, so what they found is approximately 8% prevalence in patients on hemodialysis, so we recommend anyone on hemodialysis to get a Hepatitis C antibody check and possibly check it every six months to every twelve months they should be checked. Blood product transfusions so people who – before 1992, we didn’t really identify Hepatitis C, so if it’s prior to 1992, we didn’t know. We used to call Hepatitis C Non-A, Non-B back then for those that are old enough to remember like myself [LAUGHS]. Yeah, so the transmission happened, and then, unfortunately, some of these people did get Hepatitis C as well. Basically, it’s exposure to blood products.
Melanie: So what’s involved in the screening, and is this something that we have to go see a specialist, or do we just get it at our blood screening in our annual physical and at a certain age say, “You know what, I would really like to be screened for Hepatitis C?”
Dr. ElGenaidi: Well, obviously if you know that you have a risk for exposure, so if the person has had a history of IV drug abuse, regardless of age, they should ask their primary care doctor to check the Hepatitis C antibody, which is a blood test. The baby boomers, even if you’ve never been exposed to any of the risk factors that I mentioned, so if you’re born between 1945 and 1965, the primary care probably is already checking because it is part of their screening protocol now. It’s actually now being entered on many of the electronic medical records just as you would a colonoscopy for anyone over the age of 50 or a mammogram, so this is now becoming the standard of care – or is standard of care.
Melanie: And if somebody is diagnosed with Hepatitis C, then what do you tell them about this? Is this a permanent condition? Are there treatments to stop the progression?
Dr. ElGenaidi: Well, yes, first, once you get the diagnosis that you’ve been exposed – because the Hepatitis C antibody only tells us that the person was exposed. However, we know that 80 to 85% will have chronic Hepatitis C and there’s a lucky few that clear the virus on their own, which is about 15%. What has to be checked next is the Hepatitis C virus. Now, if the virus is positive, then you know the patient has a chronic Hepatitis C, so the next step would be referring to a specialist -- and that could be a gastroenterologist, or hepatologist, like myself -- to consider treatment.
There’s further blood work that has to be done to find out the genotype, which tells us – genotype basically means the type of Hepatitis C because we know that there’s six different types and there may be different dosing and different regimens for the different types, so that has to be established. People usually get an ultrasound as well.
Once we have all that information, we treat – and the treatments nowadays are phenomenal. We use direct-acting antivirals, which are pills basically that you take. There’s several of them out there right now on the market. The rate of clearing this virus is – basically all of them are showing us results greater than 90%, so we can safely say that we’re clearing, or eradicating the virus 90% of the time or more. Now, with some people, you can predict almost 100% that they will clear the virus. So, yes, we have good therapies now.
Melanie: So, Dr. ElGenaidi, wrap it up for us with your best advice about Hepatitis C, getting screened, and what you want people to know about the new clinic at Lourdes.
Dr. ElGenaidi: Yes, please ask your provider, internist, family practice physician, or even a cardiologist or a nephrologist, anyone can screen for the antibody. If you’ve never been screened, it’s a one-time screening checking the antibody if you are a baby boomer, or if you were at risk of possibly getting transmission of Hepatitis C. If it is diagnosed, don’t worry, don’t be upset. This is a virus that we can actually cure. Unlike any other viruses that are out there, right? So, HIV we can’t cure, Hepatitis B is not curable, but Hepatitis C definitely is. It’s important to get cured because the virus is – it’s a bad virus. It can cause a lot of problems. It can cause liver cirrhosis. It can cause liver cancer, liver failure, and the treatment is so easy. Medications are very well tolerated, so it definitely behooves you to get that checked.
Now, as far as the Hepatitis C clinic, we run the clinic in the hospital itself and what’s good about that is that we have good collaboration with specialty pharmacy that’s in the hospital. These medications are still quite expensive, and they have to be preauthorized. We have a lab right there so patients can get the labs drawn the day of their first visit. We also have ultrasound. We also have a new device called FiberScan, which measures the thickness and elasticity of the liver, which can tell us how much scar tissue is on the liver. All of this stuff is important for us to know as clinicians, as well as the insurance company, wants to know so they can help us with getting the authorizations. And then pharmacy is right there on sight, so that collaboration and all its extensive services we can provide in a one-stop-shop, it just makes it so much easier for us as well as the patients obviously. I highly recommend; come and see us.
Melanie: Thank you, so much, Doctor, for being with us today. You’re listening to Lourdes Health Talk, and for more information, you can go to LourdesNet.org, that’s LourdesNet.org. This is Melanie Cole. Thanks, so much, for listening.
Melanie Cole (Host): More than 3 ½ million Americans have chronic Hepatitis C, but many live with the disease unaware that they are infected. The "Lourdes Hepatitis C Clinic" is dedicated to the comprehensive evaluation, diagnosis and treatment for patients with all phases of hepatitis C infection. My guest today is Dr. Hisham ElGenaidi. He’s the medical director of transplant hepatology at Lourdes Health System. Welcome to the show, Dr. ElGenaidi. Tell us, what is Hepatitis C?
Dr. Hisham ElGenaidi (Guest): Well, Hepatitis C is a virus that’s transmitted blood-to-blood and what I mean to say by that is people who have used IV drug abuse in the past or people who were transfused any blood products prior to 1992, these are the general methods of how the virus is transmitted and Hepatitis C actually affects not just the liver, but it has other effects as well. It can change insulin resistance so, therefore, predisposing people to diabetes. It has some immunological changes that can happen as well, things like myoglobinuria, which can affect the kidneys and cause kidney disease. It can cause vasculitis. It has a multitude of other harms that it can do to the body, and this is why it’s so important to get screened and treated for this infection.
Melanie: So give us some stats. Tell us who should be screened and we hear baby boomers are at risk for this, tell us why?
Dr. ElGenaidi: Well, the transmission rates that occurred mostly in the 1960s and 1970s were very high. These people have all now aged, and they are in the baby boomer population. That’s anyone born between 1945 and 1965. They found that if they screened only for those that are at risk, they didn’t get a big enough bang for the buck, in other words, we weren’t catching enough Hepatitis C infections, but in the baby boomer population, we see that 1 in 30 actually does have Hepatitis C regardless of the risk factors.
So the CDC put out a notice several years ago, as well as several other societies, like the American Association of Liver Disease. This is now what we’re trying to do is get the word out, try to screen everyone that falls in that population and get them treated because over time – over many years – they were infected in the 1970s and so on. Some of these people have already developed liver cirrhosis. With liver cirrhosis, these patients can have liver failure and decompensate and require liver transplants. They can also develop liver cancer, and they may also have many of all the extrahepatic manifestations that I mentioned earlier, so it’s important that we try to get these patients in now and treat them.
Melanie: So before we talk about that screening, Dr. ElGenaidi, speak a little bit more about transmission and exposure and the way that it’s spread because, of course, some baby boomers maybe got tattoos, or they're concerned about sexual contact that they had when they were younger, or if somebody in the family has it. Speak about additional methods of transmission.
Dr. ElGenaidi: Right, so we mentioned IV drug abuse, but also the intranasal use of drugs such as cocaine snorting – the fact that they share the straw, they can actually pass it along from one person to the next. You mentioned already tattoos and piercings. Some people have gotten these tattoos many years ago prior to instituting sterile techniques, so it’s not just the needle where you can get the transmission, but it’s also the ink itself. The virus can live several days in the ink. It’s important that if people go to get tattoos that they see what’s going on, that it’s a legitimate tattoo parlor, that they’re using new ink, new needles, so that’s how to prevent that.
But other ways, sexual transmission, it can happen, but it’s not so common. We generally say transmission of approximately 10% over a 20-year period in a monogamous relationship. Obviously, if patients have other forms of sexually transmitted diseases, such as example, HIV, 30% of anyone with HIV does have Hepatitis, so it’s the same mode of transmission.
Other forms, believe it or not, is hemodialysis, so what they found is approximately 8% prevalence in patients on hemodialysis, so we recommend anyone on hemodialysis to get a Hepatitis C antibody check and possibly check it every six months to every twelve months they should be checked. Blood product transfusions so people who – before 1992, we didn’t really identify Hepatitis C, so if it’s prior to 1992, we didn’t know. We used to call Hepatitis C Non-A, Non-B back then for those that are old enough to remember like myself [LAUGHS]. Yeah, so the transmission happened, and then, unfortunately, some of these people did get Hepatitis C as well. Basically, it’s exposure to blood products.
Melanie: So what’s involved in the screening, and is this something that we have to go see a specialist, or do we just get it at our blood screening in our annual physical and at a certain age say, “You know what, I would really like to be screened for Hepatitis C?”
Dr. ElGenaidi: Well, obviously if you know that you have a risk for exposure, so if the person has had a history of IV drug abuse, regardless of age, they should ask their primary care doctor to check the Hepatitis C antibody, which is a blood test. The baby boomers, even if you’ve never been exposed to any of the risk factors that I mentioned, so if you’re born between 1945 and 1965, the primary care probably is already checking because it is part of their screening protocol now. It’s actually now being entered on many of the electronic medical records just as you would a colonoscopy for anyone over the age of 50 or a mammogram, so this is now becoming the standard of care – or is standard of care.
Melanie: And if somebody is diagnosed with Hepatitis C, then what do you tell them about this? Is this a permanent condition? Are there treatments to stop the progression?
Dr. ElGenaidi: Well, yes, first, once you get the diagnosis that you’ve been exposed – because the Hepatitis C antibody only tells us that the person was exposed. However, we know that 80 to 85% will have chronic Hepatitis C and there’s a lucky few that clear the virus on their own, which is about 15%. What has to be checked next is the Hepatitis C virus. Now, if the virus is positive, then you know the patient has a chronic Hepatitis C, so the next step would be referring to a specialist -- and that could be a gastroenterologist, or hepatologist, like myself -- to consider treatment.
There’s further blood work that has to be done to find out the genotype, which tells us – genotype basically means the type of Hepatitis C because we know that there’s six different types and there may be different dosing and different regimens for the different types, so that has to be established. People usually get an ultrasound as well.
Once we have all that information, we treat – and the treatments nowadays are phenomenal. We use direct-acting antivirals, which are pills basically that you take. There’s several of them out there right now on the market. The rate of clearing this virus is – basically all of them are showing us results greater than 90%, so we can safely say that we’re clearing, or eradicating the virus 90% of the time or more. Now, with some people, you can predict almost 100% that they will clear the virus. So, yes, we have good therapies now.
Melanie: So, Dr. ElGenaidi, wrap it up for us with your best advice about Hepatitis C, getting screened, and what you want people to know about the new clinic at Lourdes.
Dr. ElGenaidi: Yes, please ask your provider, internist, family practice physician, or even a cardiologist or a nephrologist, anyone can screen for the antibody. If you’ve never been screened, it’s a one-time screening checking the antibody if you are a baby boomer, or if you were at risk of possibly getting transmission of Hepatitis C. If it is diagnosed, don’t worry, don’t be upset. This is a virus that we can actually cure. Unlike any other viruses that are out there, right? So, HIV we can’t cure, Hepatitis B is not curable, but Hepatitis C definitely is. It’s important to get cured because the virus is – it’s a bad virus. It can cause a lot of problems. It can cause liver cirrhosis. It can cause liver cancer, liver failure, and the treatment is so easy. Medications are very well tolerated, so it definitely behooves you to get that checked.
Now, as far as the Hepatitis C clinic, we run the clinic in the hospital itself and what’s good about that is that we have good collaboration with specialty pharmacy that’s in the hospital. These medications are still quite expensive, and they have to be preauthorized. We have a lab right there so patients can get the labs drawn the day of their first visit. We also have ultrasound. We also have a new device called FiberScan, which measures the thickness and elasticity of the liver, which can tell us how much scar tissue is on the liver. All of this stuff is important for us to know as clinicians, as well as the insurance company, wants to know so they can help us with getting the authorizations. And then pharmacy is right there on sight, so that collaboration and all its extensive services we can provide in a one-stop-shop, it just makes it so much easier for us as well as the patients obviously. I highly recommend; come and see us.
Melanie: Thank you, so much, Doctor, for being with us today. You’re listening to Lourdes Health Talk, and for more information, you can go to LourdesNet.org, that’s LourdesNet.org. This is Melanie Cole. Thanks, so much, for listening.
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