Consider whether there is HBV or HIV coinfection or coexisting liver disease present
It is important to consider whether another liver disease is present as this increases the risk of cirrhosis being present, and will need ongoing management after viral eradication. Common comorbidities include excessive alcohol consumption, diabetes, obesity and non-alcoholic fatty liver disease.
Coinfection with hepatitis B virus (HBV) or human immunodeficiency virus (HIV) is more common in people with HCV infection than in the general population. It is therefore important to perform a targeted assessment in all patients, including calculation of body mass index and measurement of blood pressure, waist circumference, fasting glucose level and lipid levels, as well as HBV and HIV serology. All people with chronic HCV infection should be vaccinated against hepatitis A virus (HAV) and HBV if seronegative.
Testing for other causes of liver disease, including haemochromatosis, autoimmune hepatitis, primary biliary cholangitis, Wilson disease and alpha-1-antitrypsin deficiency, can be reserved for individuals whose liver function test results do not normalise once HCV infection has been cured, or in whom there is a high index of clinical suspicion. For people aged > 50 years in whom it is planned to use ribavirin-containing regimens, it is important to consider the complications of anaemia and screen for cardiovascular disease with directed history plus an electrocardiogram. For people with cardiovascular disease, a regimen that does not involve ribavirin may be most suitable.