Diagnosed chronic hepatitis C, what next?

Having made a new diagnosis of HCV infection and provided counselling, there are several steps to cover with your patient including:

  • Notification to the Department of Health (if applicable in your jurisdiction)
  • Further investigations required for all patients with chronic hepatitis C
  • Discussion of testing of contacts / friends’ group
  • Remember, anyone with chronic infection over 18 years with a Medicare card is eligible for treatment, regardless of current or past injecting

Notification

  • Notification of newly-acquired and chronic (or unspecified) HCV by is required by laboratories in all States and Territories.
  • Notification by medical practitioners is required in all jurisidictions except Tasmania. Check your jurisdictional Department of Health website for more information.
  • For Victorian medical practitioners, click here to download a hepatitis C notification form.

Further investigations

 Virology (if not requested earlier with hepatitis C serology) :

  • HCV genotype and subtype
  • HCV RNA level (Quantitative)
  • Hepatitis B serology (HBsAg, anti-HBc, anti-HBs) and, if positive, Delta hepatitis serology
  • HIV serology
  • Hepatitis A serology (vaccinate if negative serology / susceptible).

For HCV genotype testing, the patient is eligible for 1 test in a 12 month period if for pre-treatment evaluation and with specialist consultation (MBS 69491). For HCV RNA level or load (Quantitative), the patient is eligible for 2 tests in a 12 month period if for pre-treatment evaluation or efficacy of treatment and with specialist consultation (MBS 69488).

Co-infection with HIV or hepatits B has significant implications for treatment so testing must be done routinely. If co-infection is present, then specialist review is required before treatment.

Other investigations:

  • FBE, LFTs, U&E, eGFR, INR
  • Pregnancy test for all women of childbearing age
  • Liver ultrasound to identify liver cancer (HCC)
  • Consider testing for sexually transmitted infections
  • An ECG should be performed if ribavirin therapy is planned and aged > 50 years, or if there are cardiac risk factors.

Assessments for liver fibrosis 

Patients confirmed with chronic hepatitis C, should be assessed for liver fibrosis initially with an APRI (AST to platelet ratio index) score. An APRI score of >1.0 requires further investigation to exclude cirrhosis. A score of ≤1.0 may allow for GP management without the need for a FibroScan® *.

To download the recommended pathway for liver assessmentclick here.

* FibroScan® is a rapid, painless, non-invasive alternative to liver biopsy and a useful tool for easily detecting those at risk of severe liver disease. It assesses the 'hardness' (or stiffness) of the liver, and therefore the degree of liver fibrosis or scarring. It helps exclude advanced liver disease, especially in patients with long-standing infection or abnormal LFTs. FibroScan® is not MBS subsidised. Access to FibroScan® can be facilitated through tertiary hospital services and specialist liver clinics.