By Stephen Harrison, M.D., Gastroenterologist and Hepatologist, Medical Director of Pinnacle Clinical Research, and Visiting Professor of Hepatology, University of Oxford
During Hepatitis Awareness Month this May, it’s important to learn about the hidden epidemic of hepatitis C virus (HCV), encourage at-risk individuals to get tested and raise awareness about the nation’s significant and growing fatty liver disease (FLD) epidemic.
Millions of Americans who are living with HCV, the most common cause of liver disease, will develop a chronic infection that, if left untreated, can cause serious health problems, including liver disease, cirrhosis, liver failure and liver cancer.
Fortunately, a growing number of physicians are acquiring the noninvasive tool of vibration-controlled transient elastography (VCTE): an ultrasound-based technology that is quickly becoming the exam of choice for detecting and monitoring liver disease.
HCV and Fatty Liver Connection
Because people with HCV often have no symptoms, the CDC recommends that all adults and pregnant women get tested for the disease, as well as anyone with ongoing risk and certain medical conditions. Currently, no vaccine exists to prevent HCV, but treatments are available and can cure HCV—reducing liver cancer risk by 75%.
Non-alcoholic fatty liver disease (NAFLD), the build-up of fat in the liver not caused by alcohol, can lead to non-alcoholic steatohepatitis (NASH), an asymptomatic, progressive and burgeoning liver disease that can lead to increased liver-related mortality and morbidity. NASH causes liver damage and scarring, also known as fibrosis, which can get worse over time and lead to cirrhosis. VCTE-defined hepatic fibrosis is associated with obesity, metabolic syndrome, diabetes, hypertension and high-density lipoprotein cholesterol.
One study on how NAFLD impacts patients treated and cured for HCV found that NAFLD identified in patients prior to treatment persisted after curing their HCV infection. Among those with NAFLD before treatment, 6.25% still had significant liver scarring after their HCV infection was cured.
VCTE: Non-Invasive Exam
Recent studies show that VCTE is a non-invasive and quick way for clinicians to quantify the stiffness of liver tissue and estimate liver fat at the point of care. This technology can be used to measure liver stiffness either before or after anti-viral treatment, making it a critical tool in determining the development of hepatocellular carcinoma (HCC), decompensated liver disease and death. Patients with NAFLD also have an increased risk of coronary artery disease compared to the general population.
Fortunately, VCTE tools, such as FibroScan, are covered by Medicare, Medicaidand many insurance plans, and can be operated by a medical assistant for immediate interpretation by a healthcare professional.
Prevention and Patient Engagement
Here’s the good news: NAFLD is reversible if caught in the early stages and accompanied by lifestyle change. The American Diabetes Association recommends maintaining a healthy weight, and regular exercise to reduce the amount of fat in the liver and for better control of blood glucose levels. In many patients, a 5-7% decrease in body weight is associated with a reduction in liver fat and inflammation.
When it comes to addressing HCV and liver disease, physicians should take a “whole person” approach to patient engagement and support behavioral changes that will lead to better outcomes and higher quality of life.