Amy Hampton
According to the Centers for Disease Control and Prevention (CDC), more than 1.1 million people in the United States are living with with HIV, and around 25 percent of those are also coinfected with hepatitis C (HCV). That number is even more alarming when you consider that consequences from HCV infection are the leading cause of death among HIV patients.

HIV/HCV coinfection is known to accelerate HCV disease progression and present a greater risk of severe liver damage. That’s why the coinfected patient population will most likely be one of the first to be treated and stands to see great benefit from advances in HCV treatment that are capable of eliminating the virus entirely in over 90 percent of infected individuals.

Get proactive about treatment

Since HCV treatment is typically more effective in patients with more robust immune systems, coinfected patients should strive to get HIV under control prior to beginning HCV therapy. Undetectable HIV viral load and a CD4 cell count greater than 200 is preferred before HCV treatment is administered.

Many coinfected patients receive treatment from different specialists for each disease state, so it is more important than ever for patients to be proactive and advocate for themselves, keeping their doctors informed of all the therapies they are receiving. Advancements in HIV therapy have made it more common for non-specialists to manage treatment, but gastroenterologists, hepatologists and infectious disease specialists tend to stay more up to date on advances in HCV medication and managing coinfected patients.

HIV and HCV affect each other greatly and patients who take active roles in coordinating their own care and asking physicians about new treatment options are more likely to experience better outcomes. More thoroughly, pharmacist led medication therapy management programs are proven to improve outcomes for HIV patients. A study published in 2012 by Curant Health CEO Patrick Dunham and others demonstrated that for a population of patients taking Highly Active Antiretroviral Therapy (HAART), the percentage of patients whose viral loads were considered undetectable increased from 28 percent to 66 percent with medication therapy management.

Patients under the care of doctors and pharmacists that do not keep abreast of new treatment options should consider seeking more capable healthcare professionals.

Overcoming red tape

Though highly effective, new HCV treatments are expensive. Recently introduced Sovaldi can clear HCV in 12 weeks in most patients, but it costs $1,000 per pill and insurance companies can be reluctant to authorize reimbursement.

Medication management companies that dispense medications like Sovaldi can often assist patients seeking prior authorization from payers to cover treatment. The process can involve hours on the phone and seemingly endless communication back and forth, but medication management companies have a great deal of experience with this and are great resources in helping to streamline approval. Their experience with the necessary paperwork can supplement busy clinicians who may be too busy or unfamiliar with the complex documentation to file it correctly.

Even when authorized to receive treatment, many patients are left with excessive co-pays that they cannot afford. Pharmaceutical manufacturer and foundation sponsored co-pay assistance programs are available to assist with this expense, but many patients lack awareness of them. Qualified staff at medication management firms like Curant Health are equipped to help patients find and apply for the programs that are the best fit for each patient.

Navigating the maze

Advancements in HCV treatment are moving at lightning speed and a highly effective once daily, single tablet therapy is expected to become available by the end of the year. It is anticipated that insurance companies will increase efforts in heavily managing hepatitis C medications with the arrival of new agents, and there is an active conversation regarding how patients will be prioritized. One hypothesis is that HCV patients coinfected with HIV and those in advanced stages of liver disease will be among the first to receive the newest therapies.

Patients who would like to be first in line are advised to align with progressive physicians that understand new treatments and to partner with a medication management company proven to improve adherence and outcomes through medication therapy management that can hasten the prior approval process, locate applicable co-pay assistance programs and improve outcomes for patients, providers and payors.
Amy Hampton is HCV program director for Curant Health. Based in Smyrna (Atlanta), Georgia, Curant Health specializes in medication therapy management to improve adherence and outcomes for patients with chronic diseases and the health care providers and payors that serve them.