Hepatitis%20c Management
General Care
- Supportive care
- Consider hospitalization if there is vomiting, dehydration, signs of hepatic decompensation
- Evaluate for advanced fibrosis or other conditions that may hasten liver fibrosis (eg HBV and HIV infections, genotype 3, nonalcoholic fatty liver disease) to help guide treatment
- Monitor for HCC with alpha-fetoprotein and liver ultrasound every 6 months in those with advanced fibrosis
- Screen for other sexually-transmitted diseases in cases of sexually acquired hepatitis or if otherwise appropriate
- Identify extrahepatic manifestations and treat comorbidities appropriately
- Test for HIV infection, past or current HBV infection and for hepatitis A virus immunity and search for other causes of liver comorbidities
Prevention
Primary Prevention
- At present, there is no available vaccine for HCV
- The prevention of HCV would depend on the reduction of the risk of exposure especially in patients in healthcare setting and those who are in a high-risk population (eg IV drug use and through sexual contact)
- HCV RNA should be assessed at 6 or 12 months after SVR to monitor for HCV reinfection in the high-risk population
- Recommended primary intervention:
- Hand hygiene should include proper surgical hand preparation, hand washing and use of gloves
- Appropriate and safe use of healthcare injection
- Proper handling and disposal of sharp needles and other objects and waste
- Comprehensive harm-reduction services should be provided to PWID including the use of sterile injecting equipments and treatment of dependence
- Sterilization of equipments
- All healthcare personnel should be trained
- Donated blood should be tested for HBV, HCV, HIV and syphilis
- Proper and consistent use of condoms should be promoted
Secondary and Tertiary Prevention
- Recommendations for people who are infected with HCV:
- Conduct an education and counseling program for patient care and treatment, including risk of reinfection and prevention of HCV transmission
- Immunization with hepatitis A and B vaccines are recommended to prevent coinfection and provide protection to the liver
- Early and appropriate medical management including use of antiviral therapy
- Regular monitoring is the key to early diagnosis of chronic liver disease
- Continue hepatocellular carcinoma surveillance every 6 months in patients with advanced fibrosis and cirrhosis as an SVR will only reduce but not remove the risk of hepatocellular carcinoma
Follow Up
- Measure liver function tests and HCV RNA at end of therapy and 12 weeks later
- If HCV RNA is undetectable, sustained virologic response (SVR) has been achieved
- Monitor patient for HCV recurrence
- If SVR is not achieved, consider retreatment for chronic HCV
- Monitor patient for disease progression: Assess patient every 6-12 months with CBC, liver function tests and INR; ultrasound surveillance with or without alpha-fetoprotein testing every 6 months for hepatocellular carcinoma
- If HCV RNA is undetectable, sustained virologic response (SVR) has been achieved