Hepatitis C

• Liver failure (rapid decline in hepatic function in patients) with red flags which include:
  • jaundice
  • ascites
  • hepatic encephalopathy
  • haematemesis (e.g. variceal bleeding)
• Sepsis in a patient with cirrhosis
• Spontaneous bacterial peritonitis
• Severe ascites restricting movement and breathing or causing abdominal pain

•  Deteriorating LFTs (e.g. rising bilirubin, alanine aminotransferase ALT and/or INR) without red flags

To contact the relevant service, see Clinician Assist WA: Acute Gastroenterology assessment (external site)

• History of chronic hepatitis C infection that cannot be managed in community or via remote consultation
• Cirrhosis as evidenced by
  • Fibrosis-4 index panel (FIB-4) > 3.25 AND
    • Hepascore > 0.8 OR
    • Shear Wave Elastography (SWE) liver 9-13 kPa OR
    • Fibroscan® liver stiffness measure (LSM) > 12.5kPa OR
• Co-infection
  • Other viral hepatitis
• Prior antiviral treatment failure             

This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.

• Relevant history, onset, duration, and severity of symptoms
• Alcohol consumption
• History of IV use
• Current medications list
• Any known allergies

• Height and weight, or BMI

• FBC
• U&E
• LFT (including AST)
• HCV serology (HCV RNA, anti-HCV)
• HBV serology (HBsAg, anti-HBc, anti-HBs)
• HIV serology
• HAV serology

• Substance abuse history

• Nil

• Fibrosis-4 index panel (FIB-4) value
• INR
• Previous LFT
• Alpha Fetoprotein (AFP)
• Fasting glucose and lipids
• Fibroscan® liver stiffness measure (LSM)
• Upper abdominal ultrasound (US)
• Previous imaging and/or liver biopsy results
• Pregnancy testing for women of child-bearing age        

Category 1

Appointment within 30 days

• Acute and/or chronic hepatitis C with red flags (i.e. evidence of liver decompensation e.g. jaundice, ascites)  

Category 2

Appointment within 90 days

• HCV RNA ‘detected’ with the presence of advanced fibrosis as defined by:
  • Fibrosis-4 index panel (FIB-4) score > 1.45 AND
    • Hepascore > 0.5 OR
    • Liver elastography score > 8 kPa
• Acute hepatitis C without red flags (i.e. no evidence of liver decompensation e.g. jaundice, ascites)           

Category 3

Appointment within 365 days

• HCV RNA PCR ‘detected’ without evidence of advanced fibrosis
• After failed antiviral treatment
• Cannot be treated in primary care by remote consultation (treatment is not available in regional areas)        

•  HCV antibody positive only and HCV RNA ‘not detected’

• Hepatitis C is a notifiable disease (report within 24hours of diagnosis)
• See Clinician Assist WA - Chronic Hepatitis C
• Australian consensus recommendations for the management of hepatitis C infection
• HCV RNA (patient is eligible for one test per year under Medicare not on treatment)
• Fibrosis-4 calculator

Medical Management

• Screening and vaccination for hepatitis A for patients
• Screening and vaccination for hepatitis B of sexual contacts and immediate family members
• Natural history of disease, transmission risks and precautions,
  • Lifelong monitoring of disease if advanced fibrosis/cirrhosis
• Lifelong monitoring of disease for hepatocellular cancer screening with 6-monthly ultrasound (US) and Alpha Fetoprotein (AFP) if advanced fibrosis/cirrhosis disclosure and treatment options
• For community prescribers and information: hepatitis WA
• Consider remote consultation referral see Clinician Assist WA – Hepatitis C Remote Consultation Requests