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San Francisco VA Medical Center and Hepatitis C

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San Francisco VA Medical Center and Hepatitis C

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    1. San Francisco VA Medical Center and Hepatitis C Alexander Monto, M.D. Assistant Professor in Medicine, University of California, San Francisco Gastroenterology/Hepatology, San Francisco Veterans Affairs Medical Center May 10, 2010

    2. Prevalence- HBV, HCV, HIV

    3. Hepatitis C at SFVAMC Estimated prevalence of chronic HCV infection: USA: 1-2 % Veterans using VA: 5 % SFVAMC point-prevalence: 17.7% Briggs ME et al, Hepatology 2001;34:1200 >80% of patients in SFVAMC Liver Clinic have hepatitis C

    4. Patients in VA Care with HCV: Cirrhosis and HCC FY 2005-2007

    5. Hepatitis C Infection: Disease Progression

    6. Anti-Hepatitis C Therapy Current therapies: 1) Interferon Alpha-2b, 3M.U. sq tiw + Ribavirin 1000-1200mg po qd in divided doses (Rebetron) 2) PEG-Interferon Alpha-2b 1.5 mcg/kg sq qwk + Ribavirin 1000-1200mg po qd (PEG-INTRON + Ribavirin) 3) PEG-Interferon Alpha-2a 180 mcg sq qwk + Ribavirin 1000-1200mg qd (PEGASYS + Ribavirin) www.hepatitis.va.gov

    7. PROVE 1 and 2: Telaprevir Results Treatment-Na�ve Genotype 1-Infected Patients

    8. What Does the VA Offer: HCV Detection, Tx, Care Testing VA patients who have risk factors for having hep. C was a �performance measure� several years ago- led to markedly increased detection (HCV Ab+) All honorably discharged U.S. military veterans are eligible for care in VA Most VA patients receive full care without copays: HCV treatment, liver transplant, etc. Copays for some medications

    9. Unique Needs of Veterans: HCV HCV very prevalent among Vietnam-era veterans (6-8%) Longstanding infection, so now many complications of cirrhosis: HCC, liver failure PTSD, substance use Social support

    10. Lessons Learned/Service Gaps Layers of testing, follow-up in all patients with risk factors for HCV HCV therapy is very labor-intensive Access to specialty care is important (HCV treatment, cirrhosis management) Housing, getting to SFVA: obstacles

    11. Interacting with Mayor�s SF Hepatitis C Task Force SFVA is here to provide comprehensive support to patients who qualify We will be happy to have �visitors� to learn about HCV therapy or cirrhosis management alex.monto@ucsf.edu

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