VOLUME 40 : NUMBER 2 : APRIL 2017 ARTICLE
Managing hepatitis C in general practice Simone I Strasser Associate professor AW Morrow Gastroenterology and Liver Centre Royal Prince Alfred Hospital Sydney Keywords antiviral drugs, cirrhosis, hepatitis C Aust Prescr 2017;40:64–9 http://dx.doi.org/10.18773/ austprescr.2017.017 First published online 7 March 2017
SUMMARY All people with risk factors for hepatitis C should have a serological screening test for antihepatitis C antibodies. A positive screening test should be followed by a test for hepatitis C RNA to confirm the diagnosis. The hepatitis C genotype and viral load should then be determined. The severity of fibrosis should be assessed by clinical and laboratory assessment and the use of non-invasive serum scores. Transient elastography is particularly recommended when serum scores do not clearly exclude cirrhosis. Patients with a high likelihood of cirrhosis should be managed in a specialist setting. Patients with chronic hepatitis C should be treated with oral direct-acting antivirals. The treatment regimen and duration should be selected according to hepatitis C genotype, viral load, previous treatment experience and the presence or absence of cirrhosis. Adherence to the antiviral regimen is essential. To establish whether treatment was successful, patients should be tested for hepatitis C RNA 12 weeks after completing treatment.
Introduction All oral, direct-acting antiviral treatments for chronic hepatitis C are highly effective and well tolerated. Approximately 95% of patients will be cured with a short course of treatment. These new treatments are available on the Pharmaceutical Benefits Scheme (PBS), and have a very wide prescriber base that includes GPs. Australia therefore has the potential to markedly reduce the number of people living with hepatitis C in the next 10–15 years. New cases will become rare, and rates of hepatitis C-related advanced liver disease, liver failure, liver cancer and liver transplantation will decrease.1
Box When to refer patients with hepatitis C to a specialist or liver clinic Cirrhosis * Hepatitis B co-infection HIV co-infection † Complex comorbidities and medication requirements Chronic kidney disease (eGFR
Managing hepatitis C in general practice Simone I Strasser Associate professor AW Morrow Gastroenterology and Liver Centre Royal Prince Alfred Hospital Sydney Keywords antiviral drugs, cirrhosis, hepatitis C Aust Prescr 2017;40:64–9 http://dx.doi.org/10.18773/ austprescr.2017.017 First published online 7 March 2017
SUMMARY All people with risk factors for hepatitis C should have a serological screening test for antihepatitis C antibodies. A positive screening test should be followed by a test for hepatitis C RNA to confirm the diagnosis. The hepatitis C genotype and viral load should then be determined. The severity of fibrosis should be assessed by clinical and laboratory assessment and the use of non-invasive serum scores. Transient elastography is particularly recommended when serum scores do not clearly exclude cirrhosis. Patients with a high likelihood of cirrhosis should be managed in a specialist setting. Patients with chronic hepatitis C should be treated with oral direct-acting antivirals. The treatment regimen and duration should be selected according to hepatitis C genotype, viral load, previous treatment experience and the presence or absence of cirrhosis. Adherence to the antiviral regimen is essential. To establish whether treatment was successful, patients should be tested for hepatitis C RNA 12 weeks after completing treatment.
Introduction All oral, direct-acting antiviral treatments for chronic hepatitis C are highly effective and well tolerated. Approximately 95% of patients will be cured with a short course of treatment. These new treatments are available on the Pharmaceutical Benefits Scheme (PBS), and have a very wide prescriber base that includes GPs. Australia therefore has the potential to markedly reduce the number of people living with hepatitis C in the next 10–15 years. New cases will become rare, and rates of hepatitis C-related advanced liver disease, liver failure, liver cancer and liver transplantation will decrease.1
Box When to refer patients with hepatitis C to a specialist or liver clinic Cirrhosis * Hepatitis B co-infection HIV co-infection † Complex comorbidities and medication requirements Chronic kidney disease (eGFR
