A Discussion With Douglas Dieterich, M.D., and Daniel Fierer, M.D.
Framing the Message
Myles Helfand: I'll close with a general patient management question: What do you tell your newly diagnosed patients about their prognosis? About what they should be expecting to experience over the next few months?
Douglas Dieterich: In terms of the treatment of hepatitis C, what I tell my patients is that it's a really good time to have hepatitis C. There are about 30 new drugs on the way. We're almost certain to be able to cure your disease at some point in the very near future.
In terms of the acute hep C, Daniel, I'll let you take it for those recommendations.
Daniel Fierer: I think the idea is to try to get people treated really early. I can say the same thing to the patient: that the chance of cure, right up front, right now, is extremely high. It's close to 90 percent, I'd say, in our hands here. And the few people who aren't cured here, they will be in the same boat of having really great drugs in a couple of years. So this is a great time to have hep C. If you can have it now and not be super-sick from it already, then we're really going to be able to get people cured.
To reassure people: I think there are probably very few people who can't wait six months [to start HCV treatment]. We know about those people already, probably. They're clinically sick.
Douglas Dieterich: There may be other reasons that people want to be treated, and not just for the severity of their illness. Social reasons: They're getting married; they want to have a kid; they're leaving the country; they're changing insurance; they're getting Medicare and there are donut hole issues; while they have good insurance, they want to be treated now; etc. There are lots of social reasons to be treated now.
But there are probably not a lot of medical reasons. We're treating almost everybody now, compared to what we were doing two years ago.
Myles Helfand: It's an important point: That as clear as the clinical realities are, there might be social things that you need to get at as a provider in order to be able to really tease out whether the person is a good candidate for starting -- and whether, when they start, they will stick to that treatment until the course is complete.
Daniel Fierer: We believe most everybody now is a good candidate. The days of over-scrutinizing who might be a good candidate are over. As the amount of interferon decreases and the treatment effectiveness goes up, everyone becomes a good candidate.
Myles Helfand: Thank you both.
This transcript has been edited for clarity, grammar and length.
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Myles Helfand is the editorial director of TheBody.com and TheBodyPRO.com.
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