Managing hepatitis c in general practice

Abstract

All people with risk factors for hepatitis C should have a serological screening test for antihepatitis C antibodies. A positive screening test should be followed by a test for hepatitis C RNA to confirm the diagnosis. The hepatitis C genotype and viral load should then be determined. The severity of fibrosis should be assessed by clinical and laboratory assessment and the use of non-invasive serum scores. Transient elastography is particularly recommended when serum scores do not clearly exclude cirrhosis. Patients with a high likelihood of cirrhosis should be managed in a specialist setting. Patients with chronic hepatitis C should be treated with oral direct-acting antivirals. The treatment regimen and duration should be selected according to hepatitis C genotype, viral load, previous treatment experience and the presence or absence of cirrhosis. Adherence to the antiviral regimen is essential. To establish whether treatment was successful, patients should be tested for hepatitis C RNA 12 weeks after completing treatment.