Should DOMs Screen for Viral Hepatitis? (Part I)
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Should DOMs Screen for Viral Hepatitis? (Part I)

Doctors of Oriental Medicine (DOMs) can do a great deal to assist patients who have hepatitis C (HCV) manage the disease; maintain quality of life; and tolerate standard treatment.  DOMs are considered primary care providers in New Mexico, which means they can share the responsibility to their patients to screen for HCV, and educate & refer as needed. The Center for Disease Control and Prevention (CDC) recommendations that primary care providers now routinely screen baby-boomers (those born between 1945 - 1965). In addition to:

  • HIV + individuals
  • IV drug users (even once in their  entire lifetime)
  • Received clotting factors before 1987 (e.g. hemophiliacs)
  • On long-term dialysis
  • Have elevated ALT (2 tests 6 months apart)
  • Received a transfusion or organ transplant before July 1992
  • Children of HCV+ mothers
  •  Anyone who has a history of receiving a tattoo or body piercing under non sterile conditions.
  • (maybe Vietnam veterans with history of active duty)

HCV infection is described as a “Silent Pandemic” by the Economist Intelligence Unit (2012). HCV is predicted to be a significant financial burden on the health care system within 10 years. Seventy-five percent of individuals who are chronically infected with HCV do not even know they are infected (Baby-boomers fall into this category). This is because the disease can remain asymptomatic, or present with only vague signs & symptoms for decades. Only in 10 years may these individuals be finally experiencing the sings and symptoms of HCV. A small percentage of these individuals will be experiencing advanced HCV with higher grade fibrosis, cirrhosis, hepatocellular carcinoma, or hepatic failure from HCV. They may require routine lab monitoring; recieve standard treatment; or qualify for liver transplantation.

 "Most patients who are diagnosed with end-stage liver disease with HCV infection were born between 1945 and 1965... Members of this birth cohort represent > 90% of the patients who need liver transplantation at this time" (Biggins et al, 2012). Clinical Care Options (2013, p. 8) cites that the prevalence of HCV in the baby-boomer cohort is 3.25%, and screening is cost effective when the prevalence of HCV infection in a cohort is > 0.84%.
The cost of screening is further off-set by the CDC online widget where one can self-screen for HCV. 

The standard treatments for HCV can be curative! Treatment has evolved rapidly and drastically over the past few decades. Dual therapy with peginterferon & ribavirin  or Triple Therapy with peginterferon & ribaviirin, plus HCV protease inhibitors was protracted with many side-effects. It was expectedly difficult to tolerate these treatments with maximum dose & duration with minimal side effects. Treatment with new drugs such as Boceprevir and Telaprevir are much more efficient with less if any uncomfortable side effects to hinder compliance. There is also less disparity between the effectiveness of these new drugs for different HCV genotypes.

Integrative  Medicine  Tips
  • Progressive Medical Education offers a 6-month training on the treatment of HCV using Integrative Medicine (Western, Eastern & Naturopathic). This 6- month course with grand rounds is open to DOMs, NDs, MDs, DOs, RNs, and Allied Health professions. 
  • The Center for Disease Control and Prevention (CDC)- Viral Hepatitis Resource Center (2012)  has a nifty resource for learning how to read and understand the serology test results for the various types of hepatitis. This “Viral Hepatitis Serology Training"  has two parts. Part 1 consists of animated graph tutorials tracing the serological history over the natural course of hepatitis A, B, C, D & E. Part 2 consists of case study quizzes.

Should DOMs Screen for Viral Hepatitis (Part 2).


References
Biggins,  S.,  Bambha,  K.,  Terrault,  N.  et al. (2012). Projected future increase in aging hepatitis C
     virusinfected liver transplant candidates: a potential effect of hepatocellular carcinoma.
     Liver Transplant 18, 1471-1478.
Center for Disease Control and Prevention, Viral Hepatitis Resource Center. Online serology training. Retrieved from
Center for Disease Control and Prevention, Morbidity and Mortality Weekly Report. (2012).
     Recommendations for the identification of chronic hepatitis C virus infection among persons
     born during 1945 – 1965.  Recommendations and Reports 61(4).
Clinical Care Options. (2013). Screening for HCV and initial care of newly diagnosed patients.
     Annual Report.
The Economist Intelligence Unit. (2012). The silent pandemi: Tackling hepatitis C with policy
     innovation. The Economist.






2 Comments to Should DOMs Screen for Viral Hepatitis? (Part I):

Comments RSS
J.R. Means on Monday, November 25, 2013 10:13 AM
Very informative, yet extremely concerning that 75% are unaware of exposure. A "silent pandemic" indeed...
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JR Means on Monday, November 25, 2013 10:17 AM
A silent pandemic indeed. Extremely concerning that 75% of carriers are unaware of their status. Very informative topic...
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