What Specialist Treats Hepatitis C?
Hepatitis C can be effectively managed by multiple types of specialists, including hepatologists, gastroenterologists, and infectious disease specialists, with the choice depending on disease complexity and local expertise. 1
Primary Treatment Providers
Specialists Who Commonly Treat HCV
Hepatologists and gastroenterologists are the most frequently involved specialists for HCV management, particularly for patients with advanced fibrosis, cirrhosis, or complex medical histories 1
Infectious disease specialists also commonly manage HCV treatment and are equally qualified to provide antiviral therapy 1
Primary care physicians and family physicians can manage uncomplicated cases in patients without cirrhosis or significant comorbidities, provided they have appropriate education and experience with HCV treatment 2, 3
When to Refer to a Specialist
Patients Requiring Specialist Care
Patients with the following characteristics should be referred to a hepatologist, gastroenterologist, or infectious disease specialist: 1, 2
Decompensated cirrhosis (Child-Pugh score ≥7, including ascites, hepatic encephalopathy, total bilirubin >2.0 mg/dL, albumin <3.5 g/dL, or INR ≥1.7) 1
Prior HCV treatment failure requiring retreatment evaluation 1
End-stage renal disease (eGFR <30 mL/min/m²) 1
Known or suspected hepatocellular carcinoma 1
Prior liver transplantation 1
Current pregnancy 1
Significant comorbidities that complicate treatment decisions 2
Patients Suitable for Primary Care Management
Patients without advanced fibrosis and without significant comorbidities can be treated by educated primary care physicians: 2
Treatment-naive patients with no cirrhosis or compensated cirrhosis (Child-Pugh A) 1, 2
Patients who can adhere to simplified treatment regimens (glecaprevir/pibrentasvir for 8 weeks or sofosbuvir/velpatasvir for 12 weeks) 1, 2
Multidisciplinary Team Approach
Recommended Team Composition
HCV treatment should ideally be delivered within a multidisciplinary team setting with experience in HCV assessment and therapy: 1
Clinical assessment and monitoring by physicians and nursing staff 1
Virology services for RNA testing and genotyping 1
Pharmacy services for drug-drug interaction assessment 1
Drug and alcohol services for patients with substance use 1
HIV infection services for coinfected patients 1
Psychiatric support for selected cases 1
Social work and peer support services for patients with socioeconomic disadvantages 1
Common Pitfalls to Avoid
Do not delay referral for patients with decompensated cirrhosis or complex medical conditions, as these require specialized expertise 1, 4
Do not exclude patients with active substance use from treatment—active drug use is not a contraindication to HCV therapy, though these patients benefit from harm reduction programs and additional support 1, 4
Do not overlook the need for ongoing surveillance in cirrhotic patients even after achieving cure, as hepatocellular carcinoma risk persists and requires specialist follow-up 1, 5
Ensure proper assessment of drug-drug interactions before initiating therapy, particularly in patients taking multiple medications—pharmacist involvement is valuable 1