Hepatitis C

For specialist advice, see Contacts for specialist advice on STIs, hepatitis and HIV.

Hepatitis C in a pregnant person: seek specialist advice and refer to Infections in Obstetrics: Hepatitis C (external site)

Refer to alcohol and drug services for opioid substitution treatment as necessary, e.g. Mental Health Commission (external site)

If your patient is continuing to engage in injecting drug use refer to the Peer Based Harm Reduction WA (external site) or a Needle and Syringe Exchange Program in their local area

Offer hepatitis A and B vaccination in accordance with Guidelines for the Provision of Hepatitis A and B Vaccine to Adults in Western Australia at Risk of Acquiring these Infections by Sexual Transmission and Injecting Drug Use (PDF 248KB).

Patient information: Hepatitis C (HealthyWA).

Most people are asymptomatic, so testing is important irrespective of symptoms.

During the initial infection people often have mild or no symptoms. Occasionally a fever, dark urine, pale faeces abdominal pain and jaundice occur.

Acute infection progresses to chronic disease in up to 75% of cases.

Chronic infection is usually asymptomatic. However, without treatment, around 20–30% of people with chronic HCV infection will develop cirrhosis. In some cases, those with cirrhosis will develop complications such as portal hypertension, liver failure and hepatocellular carcinoma.

See: ASHM Testing Portal | Hepatitis C (external site).

HCV diagnosis in Australia is based on detecting antibodies to HCV in a blood sample. A positive antibody test indicates past or current infection; these patients should have HCV RNA (NAAT)/HCV PCR testing to distinguish current/active infection (positive HCV RNA (NAAT)/HCV PCR) from past infection (negative HCV RNA (NAAT)/HCV PCR. Do NOT repeat an HCV antibody test on a person who has had a previous positive HCV antibody test as it remains positive life-long regardless of treatment.

To ensure complete and timely diagnosis of chronic HCV, reflex testing is recommended.

Reflex testing:

Request on the pathology form that:

a) if the blood sample is positive to hepatitis C antibody, to then test for HCV ribonucleic acid (RNA); and

b) if the HCV RNA test is positive, that the pre-treatment virology assessment tests (liver function tests, full blood count, HCV genotype) are also completed and use these results to calculate APRI (AST to Platelet Ratio Index). Note that AST must be specifically requested as many labs do not include it as part of standard LFTs.

As a dedicated collection tube is required to undertake the HCV RNA, requesting the above will ensure the HCV RNA can be collected at the same time as the initial screening. This will reduce the number of appointments and blood tests required for your patients and reduce the likelihood of patients being lost to follow up.

People who should be offered testing include:

• Populations with higher prevalence of chronic hepatitis C:
  • people born in intermediate and high prevalence countries
  • people who have ever injected drugs
  • men who have sex with men
  • people in custodial settings or who have been incarcerated in a custodial setting

• Populations with higher risk of onward transmission and/or adverse health outcomes:
  • pregnant people
  • infants and children born to mothers who have chronic hepatitis C
  • injecting partners of people with chronichepatitis C
  • people initiating HIV pre-exposure prophylaxis (PrEP)

• People with an illness that could be related to or associated with hepatitis C:
  • abnormal liver function tests
  • acute hepatitis
  • chronic liver disease or cirrhosis
  • hepatocellular carcinoma
  • porphyria cutanea tarda
  • vasculitis
  • cold agglutinin presentations

Hepatitis C testing is recommended for all pregnant women in the first trimester of each pregnancy (unless known to have had a previous positive HCV antibody test) to allow appropriate measures to be implemented to prevent perinatal transmission.

GPs, other medical practitioners and some nurse practitioners are eligible to independently prescribe hepatitis C treatment under the PBS without consulting an infectious diseases physician, hepatologist or gastroenterologist.

Patients who are medically suitable to be treated for hepatitis C in a general practice/primary health care setting and have a valid prescription but do not have a Medicare card can purchase generic hepatitis C medications through FixHepC (external site). See section 6.12 of WA Health Fees and Charges Manual 2023-24 for more information. 

Practitioners who wish to initiate hepatitis C treatment in consultation with an infectious diseases physician, hepatologist or gastroenterologist may do so by submitting, the remote consultation request for initiation of Hepatitis C treatment form (Word 49KB) or (PDF 248KB).

Prescribers should check for drug-drug interactions between the antiviral medication and the patient’s prescribed medication as this may determine the choice or treatment, or if modifications to prescribed medication is required. There should also be checks for illicit drugs in use as significant interactions exist. Interactions can be checked using the following link: https://hep-druginteractions.org/checker

Patients with evidence of cirrhosis should be referred to a hepatologist or gastroenterologist for hepatitis C treatment via the Central Referral Service.

Please forward the Remote Consultation Request form to the Central Referral Service by:
Secure Messaging: HealthLink secure messaging – crefserv (email)
Fax: 1300 365 056
Post: Central Referral Service
PO Box 3462
Midland WA 6056

• Contact tracing is not generally required for sexual contacts
• Contact trace and test injecting contacts
• The diagnosing doctor is responsible for initiating and documenting a discussion about contact tracing
• See Australasian contact tracing guidelines

• Confirm contact tracing of injecting contacts has been undertaken or offer more contact tracing support
• Test for HCV PCR 4 and 12 weeks after completion of treatment, if negative, counsel about possible risk behaviour and re-infection; if positive, retest at 12 weeks post treatment and if still positive refer to a specialist
• Following successful treatment or natural clearance of hepatitis C virus, HCV RNA will be negative although hepatitis C antibody will remain positive life-long
• Refer to a specialist if the HCV RNA is positive 12 weeks post-treatment
• Check for hepatitis B and other causes of hepatitis, e.g. alcohol, fatty liver
• Offer hepatitis A vaccination in accordance with Guidelines for the Provision of Hepatitis A and B Vaccine to Adults in Western Australia at Risk of Acquiring these Infections by Sexual Transmission and Injecting Drug Use (PDF 248KB).
• Educate about condom use, contraception, safe injecting practices, consent, cervical screening, vaccinations for HAV, HBV, HPV and mpox as indicated, and not sharing personal grooming items such as toothbrushes, razors, tweezers, nail clippers. 
• Refer to alcohol and drug services for opioid substitution treatment as necessary, e.g. Mental Health Commission (external site)
• If your patient is continuing to engage in injecting drug use refer to Peer Based Harm Reduction WA (external site) or a Needle and Syringe Exchange Program in their local area