hepatitis%20c
HEPATITIS C
Treatment Guideline Chart

Hepatitis C can be transmitted through blood transfusions, organ transplants, percutaneous (especially IV drug use), sexual or perinatal route.

It has an incubation period of 14-180 days.

Goal of treatment is to prevent progression to chronic hepatitis C through antiviral treatment of acute hepatitis C. Also, it aims to prevent occurrence of liver-related complications through antiviral treatment of chronic hepatitis C.

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
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