All people living with HCV infection should be considered for treatment, except those with limited life expectancy (< 12 months) due to non-liver-related or non-HCV-related comorbidities. It is important that all people considered for treatment undergo a comprehensive pre-treatment assessment (Table 1). This assessment provides the foundation for a successful virological outcome by establishing a therapeutic and collaborative relationship.
Access to peer and social support; psychological, alcohol and drug counselling; and information about preventing transmission of HCV and avoidance of HCV reinfection should be provided.
Key elements of the pre-treatment assessment are to:
- Perform a virological evaluation to:
- confirm the diagnosis of chronic HCV infection
- where possible, identify the genotype of HCV infection
- document the HCV treatment history - Evaluate for the presence of cirrhosis
- Evaluate for the presence of hepatitis B virus (HBV) or human immunodeficiency virus (HIV) coinfection
- Consider whether coexisting liver diseases are present
- Consider concomitant medications for risk of drug–drug interactions, including ethinyloestradiol-containing oral contraceptives, over-the-counter preparations and recreational substances.
- Evaluate renal function
- Discuss the need for contraception
- Discuss the importance of treatment adherence.
Table 1. Pre-treatment assessment of people with chronic hepatitis C virus (HCV) infection |
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History |
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Medication |
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Physical examination |
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Virology |
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Investigations |
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HIV = human immunodeficiency virus. HBV = hepatitis B virus. HAV = hepatitis A virus. PCR = polymerase chain reaction. HBsAg = hepatitis B surface antigen. anti-HBc = hepatitis B core antibody. anti-HBs = hepatitis B surface antibody. eGFR = estimated glomerular filtration rate. INR = international normalised ratio. ARFI = acoustic radiation force impulse. SWE = shear wave elastography. APRI = aspartate aminotransferase to platelet ratio index. EL F = Enhanced Liver Fibrosis. DAA = direct-acting antiviral. PBS = Pharmaceutical Benefits Scheme. Note: People living with hepatitis C can receive information, support and referral from community services, including: |