US Pharm. 2019;44(11)(Specialty&Oncology suppl):2.
Thanks to recent, highly effective public-health outreach programs, baby boomers—people born between 1945 and 1965—now actively seek treatment for hepatitis C infection. That’s a good thing, since these individuals, according the CDC, are five times more likely to have hepatitis C compared with other adults outside this age bracket, and many of them do not even know they are infected.
The current public-health crisis centers on addressing the serious and potentially fatal consequences of untreated viral hepatitis infection. Additionally, those with underlying, asymptomatic, and undetected illness unknowingly risk infecting others. As a result of the recent explosion of awareness of this potential infection, a number of your patients will likely receive an unexpected diagnosis, often perceived as life-altering.
The role of the pharmacist in this public-health campaign is critical. Most patients will already have been counseled at the time of diagnosis that untreated hepatitis C can lead to cirrhosis, hepatic failure, and liver cancer. However, pharmacists must underscore the importance of treatment, especially for individuals without symptoms. The pharmacist’s opportunity to share the exciting news about new antiviral treatment, which may result in a cure for the patient, is something to celebrate.
Another less commonly recognized but critical pharmacist role is assisting patients who have potential or known mental-health conditions in navigating their treatment paths. The frequent co-occurrence between hepatitis and mental illness is well documented, and it is well known that persons with mental illness are more likely to be exposed to infectious disease compared with the general population. For example, studies evaluating the incidence of hepatitis C infection in veterans have reported that up to 93% of people diagnosed with hepatitis C also have co-occurring psychiatric or substance-use disorders. In individuals with such a dual diagnosis, additional effort should be focused on avoiding treatment failure by acknowledging and addressing the cognitive impairments associated with the illness itself, as well as those potentially associated with the medication used to treat psychiatric disorders.
While the presence of mental illness is certainly not a contraindication for treatment of chronic hepatitis, it is important that patients with these co-occurring conditions receive intense education about the necessity of adherence. Adherence is essential not only to ensure their own recovery, but also to maintain antiviral efficacy for future generations and minimize risk of mutation and viral resistance.
Viral resistance associated with inappropriate anti-infective use is a societal problem and is not limited to a complication resulting from behavioral-health issues alone. It is crucial that prescribers and pharmacists assess patients for readiness for hepatitis antiviral treatment because of the challenging and lengthy course that can result in, but is not limited to, neuropsychiatric side effects and worsening of a primary mental-health condition.
To comment on this article, contact rdavidson@uspharmacist.com.
