What is the immediate treatment approach for a patient with a diagnosis of Hepatitis C (Hepatitis C virus) in the absence of a referral?

Management of Newly Diagnosed Hepatitis C Infection

All patients with confirmed Hepatitis C infection should be referred for antiviral treatment as soon as possible, even in the absence of immediate specialist referral availability, to prevent complications including liver fibrosis, cirrhosis, and hepatocellular carcinoma. 1

Initial Assessment and Education

Immediate Steps

• Confirm active infection with HCV RNA testing if not already done 1
• Assess for liver fibrosis severity using non-invasive testing (such as FibroScan or serum biomarkers) to determine treatment urgency 1
• Screen for HIV and hepatitis B coinfection, as these conditions worsen HCV prognosis 1
• Evaluate for extrahepatic manifestations of HCV that may require urgent treatment 1

Patient Education Components

• Explain that HCV is curable with modern direct-acting antiviral (DAA) therapy in >90% of cases 1
• Counsel on avoiding alcohol consumption, which accelerates liver fibrosis progression 1
• Advise on weight management for overweight/obese patients, as obesity can worsen liver damage 1
• Discuss transmission prevention methods to protect others 1
• Explain that successful treatment prevents liver complications and improves quality of life 1

Treatment Planning

Preparation for Treatment

• Determine HCV genotype to guide treatment selection 1
• Assess for potential drug interactions with current medications 1
• Screen for advanced fibrosis or cirrhosis, which affects treatment urgency and monitoring needs 1
• Document baseline liver function tests and complete blood count 1

Treatment Recommendations

• Direct-acting antiviral (DAA) therapy is recommended for all patients with chronic HCV infection, regardless of fibrosis stage 1
• Treatment regimens should be selected based on:
  • HCV genotype
  • Presence/absence of cirrhosis
  • Prior treatment history
  • Potential drug interactions 1
• For patients with significant fibrosis or cirrhosis (METAVIR F2-F4), treatment should be prioritized urgently 1

Special Considerations

Acute HCV Infection

• If acute infection is suspected (within 6 months of exposure), monitor HCV RNA for 12-16 weeks to detect potential spontaneous clearance before initiating treatment 1
• If spontaneous clearance does not occur within 12 weeks, treat with the same regimens used for chronic infection 1

Substance Use Disorders

• Active substance use is not a contraindication to HCV treatment 1
• Consider referral to addiction medicine specialists for patients with injection drug use history 1
• Emphasize the importance of harm reduction strategies to prevent reinfection 1

Monitoring and Follow-up

During Treatment

• Schedule regular follow-up visits to assess treatment adherence and side effects 1
• Monitor for potential drug interactions with any new medications 1

Post-Treatment

• Test for SVR (sustained virologic response) at 12 weeks after completing treatment to confirm cure 1
• For patients with advanced fibrosis or cirrhosis, continue surveillance for hepatocellular carcinoma even after achieving SVR 1
• Counsel patients on the importance of avoiding reinfection 1

Common Pitfalls to Avoid

• Delaying treatment: Modern DAA treatments are highly effective and should not be delayed, especially in patients with advanced fibrosis 1
• Failing to screen for coinfections: Always test for HIV and HBV, as coinfection affects prognosis and treatment 1
• Overlooking extrahepatic manifestations: HCV can cause significant non-liver related complications that may require specific management 1
• Inadequate patient education: Patients need to understand that HCV is curable and that successful treatment prevents serious complications 1

When to Seek Specialist Consultation

• Patients with decompensated cirrhosis 1
• Those with prior treatment failure 1
• Patients with significant comorbidities or complex drug interactions 1
• Individuals with HBV or HIV coinfection 1

While specialist referral is ideal, primary care providers can initiate the evaluation process, provide essential patient education, and in many cases, prescribe DAA therapy with appropriate guidance and monitoring 1.