Virology (if not requested earlier with hepatitis C serology) :
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.
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 assessment, click 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.