TranslateHepatitis C
Outpatients | Gastroenterology
This condition is treated in the Gastroenterology clinic.
Pre-referral work-up
History
The clinic's focus will be those people with advanced liver disease and those at high risk of complications including those co- infected with HIV or Hepatitis B.
Most patients with minimal liver damage can be managed in the community by Primary Care without a requirement for specialist advice for prescription completion.
Please note that direct acting antiviral medication for Hepatitis C can be prescribed by a medical practitioner experienced in the treatment of chronic hepatitis C infection; or in consultation with a gastroenterologist, hepatologist or infectious diseases physician experienced in the treatment of chronic hepatitis C infection. Those clinicians uncertain of prescribing or requiring support from the hepatology team to provide care should refer the patient to clinic
History
Please provide all requested information in your referral. Please refer patients to the clinic in your region.
Note: All referrals should comply with the Referral Standards and for all patients the following parameters assist in triage and potential choices of care. Please provide:
- Estimated duration of HCV infection
- Previous HCV treatment experience - date, regimen and response
- Co factors for liver disease progression: alcohol intake, marijuana use, virological cofactors (HIV, HBV), diabetes, obesity
- Current / past renal disease
- Ischaemic heart disease or cardiovascular risk factors
- Vaccinations history especially for Hepatitis A and B
- Physical and psychiatric comorbidities
- Ongoing risk factors for viral transmission and reinfection
- Social issues potential barriers to medication adherence Medication
- Concomitant medications (prescription, over-the-counter, illicit)
Examination
- Features of cirrhosis: hard liver edge, spider naevi, leukonychia
- Features of decompensation or portal hypertension: jaundice, ascites, oedema, bruising, muscle wasting, encephalopathy
- Weight and BMI
Tests
Pathology:
- LFT
- FBC
- U&E
- HBV serology
- HIV
- Fasting glucose Lipids results
- HCV serology
- HCV PCR
Imaging:
Upper abdominal USS
Investigations:
Nil
Interim/GP management
To refer a patient with this condition, please see the Gastroenterology clinic page for the full referral process and templates.
At any stage early referral of co-infected patients and health care workers is recommended.
Acute infection
This has evolving evidence for treatment.
Refer early to clinic those who are:
- co-infected with HIV or Hepatitis B
- health care workers
- unwell
Others repeat PCR after four weeks and review for consideration of referral for treatment if PCR remains positive.
Advise on harm minimisation from other liver toxins.
Vaccination for Hepatitis B is recommended and consider vaccination for Hepatitis A.
Further information available on the Health Pathways website.
Chronic infection
- See THS Hepatitis C Pathway. Related to this pathway you may wish to look at the following advice sheets:
- Vaccination for Hepatitis B is recommended and consider vaccination for Hepatitis A
- Liver fibrosis assessment - see page 2 of the Decision making guide.
- An overview of care and assessment is found on the ASHM website - Primary Care Providers and Hepatitis C.
- See Decision-making in Viral Hepatitis Related Advanced Liver Disease.
- Direct - acting antiviral (DAA) medicines for the treatment of chronic hepatitis C virus (HCV) infection have been associated with reactivation of hepatitis B virus (HBV) in patients with a current or previous HBV infection. Prescribers should consider retesting for Hepatitis B (recheck LFTS and HBs Ag or HBV DNA) during treatment with DAAs when the patient is known to have had Hepatitis B infection in the past; (serology= HBsAg negative, with anti HBc positive and anti HBs positive).
- For hepatitis B information please refer to the THS Outpatient Hepatitis B (HBV) Clinic page.
- Useful decision making charts for Hepatitis B can be found on the ASHM website; Decision-Making in HBV & Decision-Making in Viral Hepatitis Related Advanced Liver Disease for advanced disease.
- Please note further Prescriber Resources are available on the ASHM website.
For more information please see the HealthPathways Tasmania website.
Gastroenterology Society of Australia Hepatitis C page
Primary Health Tasmania - Hepatitis C Treatment form
Clinic appointments
? Red location flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.
Emergency
? Potentially life-threatening symptoms suggestive of
- Acute severe GI bleeding
- Acute liver failure
- Sepsis in a patient with cirrhosis
- Severe encephalopathy in a patient with liver disease
If you, or someone else, are experiencing a serious and life-threatening injury or illness call triple zero (000) immediately or go to the nearest Emergency Department.
Learn more about when to access emergency care and non-emergency care options if the injury or illness is not serious or life-threatening.
Urgent (Category 1)
- Acute and/or chronic Hepatitis C with ALT over 500
- Acute and/or chronic Hepatitis C with concerning features- select any that apply:
- Evidence of liver decompensation
- Jaundice
- Ascites
- Encephalopathy
We will endeavour to see these patients within four weeks
Urgent referrals should be accompanied by a phone call to the clinic and the relevant doctor for urgent assessment, or patient should be directed immediately to the Emergency Department.
Semi-urgent (Category 2)
Acute and/or chronic Hepatitis C without concerning features (as above).
Availability
North
Launceston General Hospital
Level 3 - Specialist Clinics
Phone: 1300 977 694
Fax: 03 6777 5227
North West
All North West referrals are managed via Mersey Community Hospital
Phone: 03 6478 5222
Fax: 03 6441 5942
South
Wellington Clinics (Level 10)
Phone: 03 6166 0000
Fax: 03 6234 3982
