What is the recommended treatment approach for a patient with Hepatitis C Virus (HCV) infection and a normal ejection fraction (66%)?

Proper Diagnosis Documentation for HCV with Normal Ejection Fraction

Document the diagnosis as "Chronic Hepatitis C Virus Infection" (or "Acute HCV Infection" if recently acquired) followed by any relevant liver disease staging, and list the ejection fraction of 66% separately as a normal cardiac finding that does not impact HCV treatment decisions. 1

Diagnostic Documentation Structure

Primary HCV Diagnosis Components

• Confirm active HCV infection by documenting positive HCV RNA by quantitative assay, as antibody positivity alone does not confirm current infection 1
• Include HCV genotype (1-6) and subtype (e.g., 1a, 1b) in the diagnosis, though this is no longer universally required before treatment with pangenotypic regimens 1, 2
• Document liver disease severity using fibrosis staging (F0-F4 or METAVIR score), as this is essential for treatment planning and prognosis 1, 2

Fibrosis Assessment Requirements

• Assess for cirrhosis presence using noninvasive markers such as transient elastography, FIB-4 score, or APRI score rather than requiring liver biopsy 1
• Document compensated vs decompensated status if cirrhosis is present (Child-Pugh classification A, B, or C) 1, 2
• Note that patients without cirrhosis (F0-F2) have excellent outcomes after achieving sustained virologic response with resolution of liver disease 1

Cardiac Status Documentation

Ejection Fraction Relevance

• The ejection fraction of 66% is normal (normal range 55-70%) and indicates preserved cardiac function that does not contraindicate or modify HCV treatment 2
• Document cardiac comorbidities separately from the HCV diagnosis, as modern direct-acting antiviral regimens have excellent safety profiles with minimal cardiac concerns 2
• No cardiac-specific modifications to HCV therapy are required for patients with normal ejection fraction 2

Complete Diagnostic Workup Documentation

Mandatory Pre-Treatment Elements

• Screen for hepatitis B virus with HBsAg testing, as HBV/HCV coinfection requires additional monitoring during treatment due to HBV reactivation risk 1
• Screen for HIV coinfection with FDA-approved HIV antigen/antibody testing, as coinfection is associated with poorer HCV prognosis 1
• Document baseline HCV RNA viral load (quantitative), which may affect treatment duration with certain regimens 1
• Assess for extrahepatic manifestations such as cryoglobulinemic vasculitis or HCV-related nephropathy, which should be documented if present 1, 2

Additional Clinical Context

• Document prior HCV treatment history if applicable, as this affects regimen selection and duration 1, 2
• Note alcohol use status, as abstinence counseling is mandatory for all HCV patients, though ongoing use is not a contraindication to treatment 1
• Document substance use history including injection drug use, as these patients achieve comparable cure rates with direct-acting antivirals when treatment-adherent 1, 2

Treatment Implications of This Diagnosis

Universal Treatment Recommendation

• All adults with chronic HCV infection should receive antiviral treatment regardless of fibrosis stage, except those with short life expectancy that cannot be remediated 1, 3
• First-line treatment is a pangenotypic direct-acting antiviral regimen such as sofosbuvir/velpatasvir 400mg/100mg once daily for 12 weeks, achieving 98% cure rates across all genotypes 3, 2
• Alternative pangenotypic option is glecaprevir/pibrentasvir for 8 weeks in non-cirrhotic patients or 12 weeks with compensated cirrhosis 2

Expected Outcomes

• Sustained virologic response (SVR12) defined as undetectable HCV RNA 12 weeks after treatment completion represents cure in >99% of patients 3, 2, 4
• Cure prevents complications including cirrhosis progression, hepatic decompensation, hepatocellular carcinoma, and death 1, 3, 2
• Patients without advanced fibrosis have complete resolution of liver disease after achieving SVR 1, 3

Critical Documentation Pitfalls to Avoid

• Do not delay treatment for patients without cirrhosis, as the universal treatment recommendation applies to all fibrosis stages 1, 3, 4
• Do not document cardiac contraindications based on normal ejection fraction, as this is irrelevant to modern HCV therapy 2
• Do not omit vaccination recommendations: document need for hepatitis A and B vaccination for susceptible patients, and pneumococcal vaccination if cirrhosis is present 1
• Do not forget HCC surveillance documentation: patients with cirrhosis (F4) or advanced fibrosis (F3) require ultrasound surveillance every 6 months indefinitely, even after achieving cure 3, 4