Hepatitis%20c Management

• 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

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

• 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