Key points for assessment and management of hepatitis C

Key points for assessment and management of people with hepatitis C are summarised in Key points for assessment and management of hepatitis C. For more detail, see Assessment before starting treatment for hepatitis C, Drug treatment for hepatitis C, Monitoring during hepatitis C treatment and Monitoring after hepatitis C treatment.

Table 1. Key points for assessment and management of hepatitis C

Key messages

Hepatitis C is curable and all Australians with hepatitis C should be considered for direct-acting antiviral therapy.

The goals of treatment are:

  • to prevent cirrhosis, liver failure and hepatocellular carcinoma
  • to prevent transmission of hepatitis C virus.

Treatment can be prescribed by specialists, general practitioners and nurse practitioners. It can be provided in various settings, including in the community and in prisons.

Key steps in pretreatment assessment

  • confirm current hepatitis C infection by testing for hepatitis C virus RNA in blood
  • ascertain whether the patient is treatment-naive, or has previously been treated with direct-acting antivirals and not cured
  • assess for the presence of cirrhosis
  • consider whether the patient has hepatitis B or HIV co-infection [NB1]
  • review medications for potential drug interactions with direct-acting antiviral drugs
  • consider pregnancy
  • consider whether the patient has decompensated liver disease

Direct-acting antiviral regimens for adults (pangenotypic regimens)

First-line therapy options for treatment-naive adults

  • glecaprevir+pibrentasvir for 8 weeks
  • sofosbuvir+velpatasvir for 12 weeks

Option for patients who are not cured with first-line therapy due to virological failure

  • sofosbuvir+velpatasvir+voxilaprevir for 12 weeks

Monitoring during and after treatment

Most patients do not require assessment during treatment.

Test hepatitis C virus RNA at least 12 weeks after completion of therapy to confirm cure of hepatitis C.

Long-term follow-up is required in some patients (cirrhosis, abnormal liver biochemistry, ongoing risk factors for hepatitis C infection, chronic liver disease).

Note: NB1: Hepatitis C infection is an indicator condition for HIV testing. If hepatitis C is identified, offer HIV testing, regardless of whether the patient has behavioural or epidemiological risk factors for HIV infection.