As cases of hepatitis C boom across Colorado and doctors work furiously to guide patients from diagnosis to cure, there is one challenge that can be surprisingly difficult. Patients have to take their medicine.
So now, as part of three ambitious studies that could radically improve the detection of hepatitis C and care for people who have it, researchers at Denver Health are trying something futuristic: a pill that will tell doctors whether a patient took it.
The pill, basically a gelcap, contains hepatitis C medicine and a microscopically small sensor that, when it hits the stomach, beams out a signal. (The sensor then dissolves harmlessly.) The signal gets picked up by a patch worn on the skin, and that patch syncs with an iPad that uses mobile networks to upload the information to the internet, where a doctor can see which patients haven’t taken their pills that day and give them a call to remind them.
Dr. David Wyles, the head of the hospital’s infectious disease division, said the pill will allow doctors to track better than ever how well people stick to a course of medication. But they also may discover vital new information about treating hepatitis C, a viral disease that impacts the liver and can be fatal but is also curable through often expensive medicines.
“We really don’t know how often you need to take your hepatitis C medication to be cured,” Wyles said.
This study — along with two others at Denver Health — comes at a time when hepatitis C cases are rising across Colorado.
The state Health Department typically logs 3,000 to 4,000 new cases of chronic hepatitis C a year. But that annual figure has been trending upward since 2011, and 2016 saw nearly 5,000 newly reported cases of chronic hepatitis C. The Health Department also estimates that, for every case it hears about, there are nearly 13 others it doesn’t.
Injection drug use is the most common risk factor seen in younger patients who are newly diagnosed, and the rise in hep C diagnoses is likely partly a result of the heroin epidemic. But baby boomers are the age group with the most reported hep C cases — a legacy of an era when blood transfusions weren’t as rigorously screened — and the virus can churn along in the body for decades without showing symptoms.
“Unfortunately, it’s just really hard to detect until it’s really serious,” said Dr. Sarah Rowan, the associate director of HIV and viral hepatitis prevention at Denver Public Health.
That leads Denver Health doctors to suspect that hep C might be even more common than believed. To test the hypothesis, they are about to launch a study that will include everyone who comes into the emergency room as a potential test subject.
The study will divide patients into two groups. One group will be asked the typical questions to determine if they are at higher risk for hep C and then offered a test if they are. In the other group, everyone will be offered a test — regardless of risk factors. Dr. Jason Haukoos, a Denver Health emergency medicine specialist who is helping to lead the study, said the results could show whether a hep C test should be just a standard part of care for everyone.
Those diagnosed with hep C could be entered into another study at Denver Health. That one will use specially trained “navigators” to help patients, who may be homeless or struggling with drug addiction, better connect with treatment.
All together, the three studies represent a massive effort by the city’s safety-net hospital to tackle the hep C boom before it becomes a full explosion. But Rowan said the benefit to Denver — including its most marginalized residents — will be worth it.
“It’s our community,” she said.
