Chronic Hepatitis C (HCV) – PDF print version

Key Dates: Published: 20-Apr-2017 by SEMPHN

Page 1 of 13

Care map information No. 1

Resources for patients, families, carers and CALD communities No. 2

Clinical resources No. 3

Aboriginal & Torres Strait Islander health No. 4

Hepatitis C and treatment goals No. 5

Assessment No. 6

Cirrhosis (Advanced fibrosis) No. 7 Investigations

No. 8

Experienced GP No. 9

New prescribers No. 10

No current HCV infection No. 11

Management No. 12

Initiating treatment with DAAs for new prescribers No. 19

Confirm infection and determine eligibility for DAAS No. 15

Confirm infection and determine eligibility for DAAs No. 16

Initiating treatment with DAAs for experienced GPS No. 18

Management No. 13

Monitoring treatment with DAAs No. 21

Long term management No. 22

Referral No. 14

Referral No.17

Liver clinics, liver specialists and GPs with a special interest in HC No. 20

Chronic Hepatitis C (HCV) – PDF print version

Key Dates: Published: 20-Apr-2017 by SEMPHN

Page 2 of 13

RETURN to Page 1 Flow Chart

1 Care map information

Quick info:

This pathway is about new curative treatments for Hepatitis C.

Approximately 250,000 Australians have Hep C in 2017.

The new treatments:

• Are easy to take

• Have minimal side effects

• Offer a cure rate greater than 95%

• Are available to any over the age of 18 who is Hepatitis C PCR positive and who holds a Medicare card. 1

The Burnet Institute feels Australia can eliminate HCV transmission by 2030. 2

To achieve this aim, people with Hep C who have alcohol abuse, IVD or pharmacotherapy should all be treated.

From October 1, 2016 a general practitioner experienced in the treatment of chronic hepatitis C infection is no longer required to

consult with a gastroenterologist, hepatologist, or infectious diseases physician when prescribing direct acting antivirals (DAAs).3

The Working Group strongly recommends that general practitioners check and document for drug interactions before prescribing

DAAs. hep-druginteractions.org

Reference:

1) Hepatitis Victoria "Be Free from Hep C" brochure. Found on their website here: (https://engonethepvic.blob.core.windows.net/

assets/uploads/files/BE%20FREE%20FROM%20HEP%20C%20brochure.pdf)

2) https://www.burnet.edu.au/projects/274_the_eliminate_hepatitis_c_partnership_the_ec_partnership

3) Thompson A. Appendix: Monitoring of patients receiving antiviral therapy for hepatitis C virus (HCV) infection: on-treatment and

post-treatment monitoring for virological response. The Medical Journal of Australia. 2016. Pages:5.

2 Resources for patients, families, carers and CALD communities

Quick info:

• Be Free from Hep C - befreefromhepc.org.au

• Better Health Channel – betterhealth.vic.gov.au/health/conditionsandtreatments/hepatitis-c

• LiverWell - liverwell.org.au

• Hepatitis Victoria - hepvic.org.au

• Hepatitis Info Line 1800 703 003

• Health Translations resources - healthtranslations.vic.gov.au

• Pharmaceutical Benefits Scheme (PBS) – pbs.gov.au/pbs/home

• Hepatitis C information in other languages - hepvic.org.au/page/1174/other-languages

3 Clinical Resources

Quick info:

• Australasian Society of HIV Medicine (ASHM) - ashm.org.au/HCV

• Be Free from Hep C (Hepatitis Victoria) For Health Professionals - befreefromhepc.org.au/health-professionals

• Department of Health – Hepatitis C Resource Manual 2nd Edition - health.gov.au

Chronic Hepatitis C (HCV) – PDF print version

Key Dates: Published: 20-Apr-2017 by SEMPHN

Page 3 of 13

• RETURN to Page 1 Flow Chart

• Gastroenterological Society of Australia (GESA) - gesa.org.au

• Pharmaceutical Benefits Scheme (PBS) - pbs.gov.au/pbs/home

• Hep C Help - hepchelp.org.au

• Hepatitis C Online – hepatitisc.uw.edu

• Hepatitis Victoria –hepvic.org.au/directory

• NPS Medicinewise - nps.org.au

• University of Liverpool – Hepatitis Drug Interactions (NB ther is also a "Liverpool HEP iChart" app to check drug

interactions available - hep-druginteractions.org

Education

• Australian College of Rural and Remote Medicine (requires membership) acrrm.org.au/home

• RACGP gp learning (requires membership) - racgp.org.au/home

• Victorian HIV & Hepatitis Integrated Training and Learning - ashm.org.au/about/VHHITAL

4 Aboriginal & Torres Strait Islander Health

Quick info:

• Fast Facts - Viral Hepatitis and the Aboriginal Community - hepvic.org.au/page/67/aboriginal-communities

• Resources from NSW publication produced by the Aboriginal Health and Medical Research Council - ahmrc.org.au/programs/2016-04-15-00-08-17/hepatitis-c.html

5 Hepatitis C and treatment goals

Quick info:

About hepatitis C (HCV)

• Transmitted by blood and percutaneous transfer

• Sexual transmission and perinatal transmission are uncommon, < 20%

• In acute infection, most people are asymptomatic. However, about 80% will become chronically infected.

• HCV is slowly progressive, but excess alcohol intake and co-infection (with hepatitis B or HIV) speed this up

• Treatment is more effective if given early.

• Chronic HCV infections carry a high risk of liver damage, cirrhosis (~20%) liver cancer (hepatocellular cancer -HCC,~1 %)

• HCV is curable – with the newer direct acting antivirals (DAAs) up to 95% of patients are cured (sustained viral

response – SVR).

• There is currently no Hep C vaccine- All patients with Hep C should be immunized against Hep A and B

6 Assessment

Quick info:

Careful and respectful history taking may be required to identify those people at higher risk of HCV.

Screening for HCV is indicated for patients with:

• Exposure to Hepatitis C transmission risk factors. Higher risk:

• Injecting drug use (may have been only once)

• Blood products or organ donor recipients before 1990 in Australia, or any time overseas

• Tattoos and body piercing

• History of imprisonment or other custodial settings

Chronic Hepatitis C (HCV) – PDF print version

Key Dates: Published: 20-Apr-2017 by SEMPHN

Page 4 of 13

RETURN to Page 1 Flow Chart

• Medical or dental treatments in countries where equipment may not have been adequately sterilised

• Needle stick injury or occupational exposure to blood or body substances e.g., healthcare workers

• Sexual partners of people with HCV

• People born in countries with high HCV prevalence e.g., Southeast Asia, Middle East, Africa

• Aboriginal and Torres Strait Islander populations

• Children born to HCV-positive mothers (low risk of transmission)

• History of HCV in a family member where blood-to-blood transmission may have occurred e.g., through sharing of

toothbrushes or shavers

• Abnormal liver function tests

• Clinical signs of liver disease. E.g. Liver cancer, acute hepatitis or liver cirrhosis.

Risk factors for liver cirrhosis:

• Male gender

• Older age at infection

• Prolonged duration of infection ( >20 years)

• Comorbidities including excessive alcohol consumption, diabetes, and metabolic syndrome

• Coinfection with Hepatitis B or HIV

Note: People with HCV and cirrhosis must be referred for specialist care as they require long-term monitoring and surveillance for complications, including liver cancer.

7 Cirrhosis (advanced fibrosis)

Quick info:

If patient has evidence of advanced fibrosis or cirrhosis refer directly to liver specialist.

CIrrhosis or advanced Fibrosis carry significant morbidities (including oesophageal varices, haemorrhage, and liver cancer)

8 Investigations

Quick info:

Practice Point: When ordering Hepatitis C antibodies, add to the pathology referral +/- qualitative +/- quantitative HCV PCR. This

will preclude the patient from requiring multiple blood samples to be collected

1) Screen with Hepatitis C antibody (anti-HCV) test. A positive HCV anti-body test indicates exposure to the virus but does not prove

current infection.

2) If HCV anti-body positive, arrange HCV PCR testing.

HCV PCR testing:

• Positive PCR confirms detection of HCV RNA, and confirms current infection.

• For HCR PCR (qualitative), the patient is eligible for 1 test in a 12 month period if HCV anti-body positive (MBS 69488) and

not on treatment.

• Once on treatment, the patient is eligible for MBS 69445 (Detection of Hepatitis C Viral RNA in a Patient Undertaking Antiviral

• Therapy for Chronic HCV Hepatitis), up to a maximum of 4 of this item in a 12 month period.

3) If HCV RNA positive (i.e. current infection), arrange further investigations.

Virology:

• HCV genotype and subtype - patient is eligible for 1 test in 12 month period if pre-treatment evaluation AND with

specialist consultation (MBS 69491)

• Hep C viral load (HCV RNA level - Quantitative) may help to determine drug dosage- patient is eligible for 2 tests in 12

month period if pre-treatment evaluation or efficacy of treatment AND with specialist consultation (MBS 69488)

• HBV (HBsAg, anti-HBc, anti-HBs), HIV, HAV serology

Chronic Hepatitis C (HCV) – PDF print version

Key Dates: Published: 20-Apr-2017 by SEMPHN

Page 5 of 13

RETURN to Page 1 Flow Chart

Other investigations:

• FBE, LFTs (including AST), U&E, eGFR, INR

• Alphafetoprotein (AFP) - HCC

• Pregnancy test for women of child bearing age

• Liver ultrasound to identify liver cancer (HCC)

• Consider testing for sexually transmitted infections

• ECG should be performed if ribavirin therapy is planned and aged > 50 years, or cardiac risk factors.

4) Assess for Liver Fibrosis

FibroScan (transient elastography – TE)

FibroScan is a non-invasive alternative to liver biopsy and a useful tool for easily detecting those at risk of severe liver disease.

• Assesses the degree of liver fibrosis.

• Excludes advanced liver disease in patients with long-standing abnormal LFTs.

FibroScan is now available in the community via a Melbourne-wide research project

Note: FibroScan is not MBS subsidised. Access to FibroScan can be facilitated through tertiary hospital services and specialist liver clinics.

Alternatives to FibroScan

Serum biomarkers for liver fibrosis stage can be used to exclude the presence of cirrhosis if access to FibroScan is limited. These include:

• APRI (AST to platelet ratio index) calculator - hepatitisc.uw.edu/page/clinical-calculators/apri

• Biochemical markers (prothrombin time, albumin, total bilirubin, and platelet count) and abdominal (hepatic) ultrasound may

assist in determining the presence or absence of cirrhosis. See Hepatitis C Online – Evaluation and Staging of Liver Fibrosis.

hepatitisc.uw.edu/go/evaluation-staging-monitoring/evaluation-staging/core-concept/all

Note: HCV RNA testing – about 20% of patients will spontaneously resolve their infection within the first year. This group is HCV anti-body positive, but HCV RNA negative. They do not have ongoing infection, only past (resolved) infection.

9 Experienced GP

Quick info:

Generally a GP should have the clinical experience of providing treatment “in consultation” for at least 10 people living with HCV

Infection - hepcguidelines.org.au/models-of-care-in-australia/gps-in-primary-care

10 New prescribers

Quick info:

GPs who have not previously prescribed DAAs for Hepatitis C should take advantage of training opportunities as well as seeking advice from experienced GPs and specialists.

Though not exhaustive, education opportunities are often available from: • Australian College of Rural and Remote Medicine (requires membership) acrrm.org.au/home

• RACGP gplearning (requires membership) racgp.org.au/home

• Victorian HIV & Hepatitis Integrated Training and Learning - ashm.org.au/about/VHHITAL

11 No current HCV infection

Quick info:

1) If negative HCV anti-body and recent exposure, repeat HCV anti-body in 3 months.

• If HCV anti-body remains negative, no further HCV follow-up is required.

• Counsel regarding reducing risky behaviors.

Chronic Hepatitis C (HCV) – PDF print version

Key Dates: Published: 20-Apr-2017 by SEMPHN

Page 6 of 13

RETURN to Page 1 Flow Chart

2) If HCV anti-body positive and HCV RNA negative, likely past infection with viral clearance.

• Repeat HCV RNA in 12 months if ongoing infection is still a concern.

3) Viral clearance does not confer lifelong immunity

12 Management

Quick info:

Advise patients to cease all complementary and alternative medicines during the treatment period with DAAs to optimise the

likelihood of cure.

13 see 12

14 Referral

Quick info:

Refer to hepatitis specialist if:

• Previously treated with regimens containing DAA medications.

• Possible cirrhosis – clinical signs or liver stiffness > 12.5 kilopascal, or APRI > 1.0.

• Concomitant medications not listed on the University of Liverpool's HEP Drug Interactions website. www.hep-druginteractions.org

• Drug interactions where assistance required.

• Patient has received amiodarone in the last 3 months.

• Pregnant or nursing female.

• Hepatitis B or HIV coinfection

GPs not experienced in management of hepatitis C should request authorisation by contacting a specialist using the Primary Care Consulation Request.

Please refer to List of Liver Clinics and Liver Specialists

Results of these investigations need to be included:

• HCV genotype, HCV RNA level, HIV, HBVsAg, HBVcAb, HBCsAb, Hb, Platelets, LFT, AST (and AST upper limit of normal),

eGFR, INR, Fibroscan or APRI.

15 Confirm infection and determine eligibility for DAAs

Quick info:

If HCV anti-body positive and HCV RNA positive, consider eligibility for treatment with DAAs and treatment options.

Eligible for treatment with DAAs

• All patients (aged > 18 years) with HCV and current infection (HCV RNA) are eligible for DAAs. When assessing patient eligibility, consider:

• HCV genotype.

• The presence or absence of cirrhosis.

• Treatment history.

• Baseline HCV RNA level.

• Current medications.

• Health status e.g., cardiac risk factors.

Chronic Hepatitis C (HCV) – PDF print version

Key Dates: Published: 20-Apr-2017 by SEMPHN

Page 7 of 13

RETURN to Page 1 Flow Chart

• Treatment options - info for patients - hepvic.org.au/page/1165/new-treatments

• PBS General Statement for Hep C Drugs info for prescribers - pbs.gov.au/info/healthpro/explanatory-notes/general-statement-hep-c

Newer DAAs

• Sofosbuvir & Ledipasvir (Harvoni)

• Sofosbuvir & Ribavarin (Sovaldi & Ibavyr)

• Sofosbuvir & Daclatasvir (Sovaldi & Daklinza)

• Paritaprevir/Ritonavir/Ombitasvir and Dasabuvir (Viekira Pak)

• Elbasvir & Grazoprevir

(Zepatier)

Treatment and genotypes

• Hepatitis C genotype 1

• sofosbuvir and ledipasvir

• sofosbuvir and daclatasvir

• paritaprevir/ritonavir/ombitasvir and dasabuvir

• elbasvir & grazoprevir

• Hepatitis C genotype 2

• sofosbuvir and ribavirin

• Hepatitis C genotype 3

• sofosbuvir and daclatasvir

• Hepatitis C genotype 4

• elbasvir & grazoprevir

• People with genotypes 5 or 6 remain limited to sofosbuvir taken with pegylated interferon and ribavirin treatment (85%

cure rate). New drugs for these genotypes are anticipated to be listed on the PBS in 2017.

Duration of treatment

Duration is 8 to 24 weeks depending on:

• HCV genotype

• presence or absence of cirrhosis

• viral load

• whether there has been prior treatment, and

• Response to previous treatment.

See Clinical Guidance for Treating Hepatitis C Virus Infection.

16 Confirm infection and determine eligibility for DAAs

Quick info:

If HCV anti-body positive and HCV RNA positive, consider eligibility for treatment with DAAs (direct acting antiviral

treatment drugs) and treatment options.

Eligible for treatment with DAAs

All patients (aged > 18 years) with HCV and current infection (HCV RNA) are eligible for DAAs. When assessing patient eligibility, consider:

• HCV genotype.

• The presence or absence of cirrhosis.

• Treatment history.

• Baseline HCV RNA level.

• Current medications.

• Health status e.g., cardiac risk factors.

Chronic Hepatitis C (HCV) – PDF print version

Key Dates: Published: 20-Apr-2017 by SEMPHN

Page 8 of 13

RETURN to Page 1 Flow Chart

Treatment options - info for patients - hepvic.org.au/page/1165/new-treatments

PBS General Statement for Hep C Drugs- info for prescribers - pbs.gov.au/info/healthpro/explanatory-notes/general-statement-hep-c

Newer DAAs

• Sofosbuvir & Ledipasvir (Harvoni)

• Sofosbuvir & Ribavarin (Sovaldi & Ibavyr)

• Sofosbuvir & Daclatasvir (Sovaldi & Daklinza)

• Paritaprevir/Ritonavir/Ombitasvir and Dasabuvir (Viekira Pak)

• Elbasvir & Grazoprevir (Zepatier)

Treatment and genotypes

• Hepatitis C genotype 1

• sofosbuvir and ledipasvir

• sofosbuvir and daclatasvir

• paritaprevir/ritonavir/ombitasvir and dasabuvir

• elbasvir & grazoprevir

• Hepatitis C genotype 2

• sofosbuvir and ribavirin

• Hepatitis C genotype 3

• sofosbuvir and daclatasvir

• Hepatitis C genotype 4

• elbasvir & grazoprevir

• People with genotypes 5 or 6 remain limited to sofosbuvir taken with pegylated interferon and ribavirin treatment (85% cure

rate). New drugs for these genotypes are anticipated to be listed on the PBS in 2017.

Duration of treatment

Duration is 8 to 24 weeks depending on:

• HCV genotype

• Presence or absence of cirrhosis

• Viral load

• Whether there has been prior treatment, and

• Response to previous treatment.

See Clinical Guidance for Treating Hepatitis C Virus Infection.

17 Referral

Quick info:

Refer to hepatitis specialist if:

• Previously treated with regimens containing DAA medications.

• Possible cirrhosis – clinical signs or liver stiffness > 12.5 kilopascal, or APRI > 1.0.

• Concomitant medications not listed on the University of Liverpool's HEP Drug Interactions website. www.hep-druginteractions.org

• Drug interactions where assistance required.

• Patient has received amiodarone in the last 3 months.

• Pregnant or nursing female.

• Hepatitis B or HIV coinfection

GPs not experienced in management of hepatitis C should request authorisation by contacting a specialist using the Primary Care Consulation Request.

Chronic Hepatitis C (HCV) – PDF print version

Key Dates: Published: 20-Apr-2017 by SEMPHN

Page 9 of 13

RETURN to Page 1 Flow Chart

Please refer to List of Liver Clinics and Liver Specialists

Results of these investigations need to be included:

• HCV genotype, HCV RNA level, HIV, HBVsAg, HBVcAb, HBCsAb, Hb, Platelets, LFT, AST (and AST upper limit of normal),

eGFR, INR, Fibroscan or APRI.

18 Initiating treatment with DAAs for experienced GPs

Quick info:

Although newer DAAs are much safer than previous peginterferon-based treatments for HCV, it is recommended general practitioners improve knowledge and skills in the diagnosis, treatment, and management of HCV, and requirements for prescribing of

DAAs under S85 and S100.

Newer DAAs Side Effects and Precautions by type

1) First step is check for drug interactions.

Medicines to treat hepatitis C interact with many different drugs. Review concomitant medicines before starting treatment using the University of Liverpool’s drug interaction checker. hep-druginteractions.org

Before starting treatment with DAAs, check contraindications and drug interactions.

Contraindications for example:

• avoid pregnancy/conception for males and females, during, and for a period after treatment (at least 6 months post-ribavirin).

• correct anaemia prior to commencing DAAs.

Drug interactions

Especially amiodarone, PPIs, anti-HIV, statins, common antibiotics.

Note: Ongoing injecting drug use (people who inject drugs – PWID) or psychiatric co-morbidity are not contraindications to treatment. To encourage completion of treatment, it is essential to engage with the patient's treatment team, including specialists,

community pharmacy, and family.

Adherence guidelines - Australasian Hepatology Assoc - hepatologyassociation.com.au

2) A GP that is experienced in the treatment of chronic hepatitis C can prescribe DAAs without the need to consult with a specialist.

If specialist approval is preferred to begin treatment, please see Referral box.

See Treatment Protocols for duration of treatment.

3) Contact the Authority Prescription Application Service on 1800 888 333 with required information for approval to prescribe DAAs.

Required information

• The hepatitis C virus genotype, and

• The patient’s cirrhotic status (non-cirrhotic or cirrhotic).

Prescribers must also document the following information in the patient’s medical records:

• Evidence of chronic hepatitis C infection (anti-HCV positive and HCV RNA positive), and

• Evidence of the hepatitis C virus genotype.

19 Initiating treatment with DAAs for new prescribers

Quick info:

Although newer DAAs are much safer than previous peginterferon-based treatments for HCV, it is recommended general practitioners improve knowledge and skills in the diagnosis, treatment, and management of HCV, and requirements for prescribing of

DAAs under S85 and S100.

Newer DAAs Side Effects and Precautions by type

Chronic Hepatitis C (HCV) – PDF print version

Key Dates: Published: 20-Apr-2017 by SEMPHN

Page 10 of 13

RETURN to Page 1 Flow Chart

General Practitioner knowledge and skills

Make sure you understand:

• How the treatments work.

• Contraindications

• Interactions

• Do they have cirrhosis? if so, refer to a specialist.

Resources to help with learning:

• Australian Recommendations for the Management of HCV Infection: a Consensus Statement 2016

• ASHM - HCV - ashm.org.au/HCV

• Victorian HIV & Hepatitis Integrated Training and Learning - ashm.org.au/about/VHHITAL

1) First step is check for drug interactions.

Medicines to treat hepatitis C interact with many different drugs. Review concomitant medicines before starting treatment using the

University of Liverpool’s drug interaction checker. hep-druginteractions.org

Before starting treatment with DAAs, check contraindications and drug interactions.

Contraindications for example:

• avoid pregnancy/conception for males and females, during, and for a period after treatment (at least 6 months post-ribavirin).

• correct anaemia prior to commencing DAAs.

Drug interactions

Especially amiodarone, PPIs, anti-HIV, statins, common antibiotics.

Note: Ongoing injecting drug use (people who inject drugs – PWID) or psychiatric co-morbidity are not contraindications to treatment. To encourage completion of treatment, it is essential to engage with the patient's treatment team, including specialists,

community pharmacy, and family.

Adherence guidelines - Australasian Hepatology Assoc - hepatologyassociation.com.au

2) Complete a Request for DAA Treatment Form for initiation of hepatitis C treatment if required.

See Treatment Protocols for duration of treatment.

3) New prescribers MUST consult with one of the specified specialists before the GP initiates newer DAAs in order to meet the

prescriber eligibility requirements for DAAs under S85. See Referral box below.

• Specified specialists include gastroenterologist, hepatologist, or infectious disease physician experienced in the treatment of

chronic hepatitis C infection.

4) Contact the Authority Prescription Application Service on 1800 888 333 with required information for approval to prescribe DAAs.

Required information

• The hepatitis C virus genotype, and

• The patient’s cirrhotic status (non-cirrhotic or cirrhotic).

Prescribers must also document the following information in the patient’s medical records:

• Evidence of chronic hepatitis C infection (anti-HCV positive and HCV RNA positive), and

• Evidence of the hepatitis C virus genotype.

20 Liver Clinics, Liver Specialists and GPs with a special interest in HCV

Quick info:

Liver Clinics and Liver Specialists

In most cases a referral is faxed to the hepatitis treatment service. Referral form

For further information, the list of clinics that are known to Hepatitis Victoria can be found below http://www.hepvic.org.au/directory/31/liver-clinics-directory

This list of Liver Clinics and services is not extensive, you may choose to search for private Gastroenterologists.

GP colleagues with expertise in HCV treatment are a good source for advice; ASHM have a list of Community Medical

Practitioners trained and experienced in the treatment of chronic Hep C here ashm.org.au/HCV/hcv-prescriber-list

Chronic Hepatitis C (HCV) – PDF print version

Key Dates: Published: 20-Apr-2017 by SEMPHN

Page 11 of 13

RETURN to Page 1 Flow Chart

Please note: fees may be charged at services marked with *

*Caulfield Endoscopy caulfieldendoscopy.com.au/

544 Hawthorn Road, Caulfield South

Phone: (03) 9595 6666

Fax: (03) 9595 6611

Email: info@caulfieldendoscopy.com.au

*Direct Endoscopy -Peninsula Liver Clinic directendoscopy.com.au/locations#frankston

141 Cranbourne Road, Frankston

Phone: 9781 5959

Fax: 9781 2644

Alfred Health,Gastroenterology Department alfredhealth.org.au/services/hp/gastroenterology

Hepatitis Clinic 99 Commercial Rd, Melbourne

&

Bayside Hepatitis Clinic 193 Bluff Rd, Sandringham

Phone: 9076 2223

Fax: 9076 6938

Alfred Health Infectious Diseases Department alfredhealth.org.au/services/infectious-diseases

55 Commercial Road, Prahran

Phone: (03) 9076 6081

Fax: (03) 9076 6528

Monash Health Liver Clinics monashhealth.org/page/Gastroenterology1

All referrals to the Monash Health Liver Clinics via central intake (Access):

Phone: 1300 342 273

Fax: 9594 2273

• Clayton (Monash Med. Centre)

Friday 9 am

• Dandenong Hospital (Outpatients)

Monday 1.30 pm

• Cranbourne Integrated Care Centre

Alternate Tuesday 1.30 pm

• Springvale (Greater Dandenong Community Health)

Wednesday 2 pm

*GastroMedicine & ENDOSCOPY- Specialist Gastroenterologists gastromedicine.com.au

Springvale 9548 5555

Mornington 5973 4444

Rosebud 5986 4444

*The digestive health centre

Dandenong (Primary location)

Phone: 9791 8788

Appointments also available at many locations across south eastern Melbourne digestivehealth.com.au

Chronic Hepatitis C (HCV) – PDF print version

Key Dates: Published: 20-Apr-2017 by SEMPHN

Page 12 of 13

RETURN to Page 1 Flow Chart

21 Monitoring treatment with DAAs

Quick info:

Monitoring of patients receiving antiviral therapy should be individualised, and may depend upon response to treatment, side-effects,

and comorbidities.

On-treatment and post-treatment monitoring of patients for virological response

22 Long term management

Quick info:

1) Patients with early-stage fibrosis and sustained viral response (SVR) to DAAs do not require long-term follow-up. SVR represents

cure.

Counsel regarding risky behaviors as anti-HCV is not protective and reinfection may occur with repeat exposure.

2) Patients with abnormal LFTs post cure need further evaluation for a second cause of liver disease.

3) Patients with cirrhosis require long-term follow-up to monitor for complications, including portal hypertension and hepatocellular

carcinoma (HCC). Specialist gastroenterology or hepatology follow up is recommended.

Long-term follow-up:

• Recall for annual review of FBE, LFTs, INR.

• Screen for liver cancer (liver ultrasound and AFP) every 6 months.

• Counsel regarding reducing liver damage e.g., alcohol reduction, care with medications.

4) Consider referral for support services - hepvic.org.au