Overview of pretreatment assessment

Assessment of patients before starting treatment for hepatitis C includes the following:

• assess for the presence of cirrhosis
• consider whether the patient has hepatitis B or HIV co-infection
• review medications for potential drug interactions with direct-acting antiviral drugs
• consider pregnancy
• consider whether the patient has decompensated liver disease.

Pretreatment assessment of kidney function is no longer routinely required because direct-acting antiviral drugs (including sofosbuvir-based regimens) do not require dosage adjustment in patients with impaired kidney function. However, measurement of kidney function may be required when assessing for complications of hepatitis C.

Clinicians may find one of the following pretreatment assessment checklists useful:

• ‘Clinical guidance for treating hepatitis C virus infection: a summary’ [URL] (Gastroenterological Society of Australia [GESA]).
• ‘Decision making in hepatitis C’ [URL] (Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine [ASHM]).