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Management and Treatment

Summary

  • It is recommended all people with chronic HCV are seen by their doctor every 6 to 12 months as it is important to regularly assess for liver disease progression and address any comorbidities that may be present.
  • Chronic HCV infection can cause long term liver disease, including cirrhosis and hepatocellular carcinoma (HCC).  ​


Hepatitis C Management in Australia

At the end of 2014, there were an estimated 230,470 people living in Australia with chronic hepatitis C infection, of whom 44,730 had severe fibrosis or hepatitis C related cirrhosis.1

An estimated 22,470 individuals initiated DAA treatment during March to June 2016.2

For details on hepatitis C treatment uptake in Australia since the PBS listing of new direct acting antivirals (DAAs) from 1 March 2016, access the monthly newsletters Monitoring hepatitis C treatment uptake in Australia.


GP Management Plan (GPMP) and Team Care Arrangements (TCAs) for HCV infection

 
To be eligible for a GPMP, the patient must have a chronic or terminal medical condition.
 
To be eligible for TCAs, the patient must have a chronic or terminal medical condition that requires ongoing treatment from a multidisciplinary team.
 
ASHM has developed the GPMP and TCAs for HCV Infection to provide GPs with best practice guidelines in the management of HCV. While this GPMP specifically relates to management of HCV, patients’ other health problems and needs are also addressed. Recommended monitoring and review guidelines are included. 

721 GP MANAGEMENT PLAN (GPMP) for HCV infection + 723 TEAM CARE ARRANGEMENTS (TCA)

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Direct Acting Antiviral Treatment

Effective direct acting antiviral (DAA) treatment for hepatitis C is availa​ble. In the majority of cases, chronic hepatitis C can now be cured. All people living with HCV infection should be considered for treatment.

The HCV genotype must be documented in the patient’s history to meet PBS criteria for the new HCV medicines, therefore this must be determined prior to treatment initiation. ​

The hepatitis C genotype determines the:

  • Treatment regimens
    • ​For genotype 1​ sofosbuvir + ledipasvir or sofosbuvir + daclatasvir ± ribavirin
    • For genotype 1​ – paritaprevir-ritonavir + ombitasvir + dasabuvir ± ribavirin
    • For genotype 2 – sofosbuvir plus ribavirin
    • For genotype 3 – sofosbuvir plus daclatasvir or sofosbuvir plus ribavirin
    • For genotype 4-6 – There are no IFN-free treatment regimens currently available on the PBS in Australia 
  • Length of treatment (usually 12 to 24 weeks)
  • Treatment response

HCV treatments are evolving rapidly with the introduction of direct-acting antiviral (DAA) drugs. These new treatments offer significant clinical benefit with SVR rates greater than 90%, low toxicity and shortened treatment duration.

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Australian recommendations for the management of hepatitis C virus infection: a consensus statement 2016

Prepared by an expert panel, this document provides guidance on epidemiology, models of care, diagnosis, pre-treatment assessment, monitoring and treatment. For full details, see the Australian recommendations for the management of hepatitis C virus infection: a consensus statement 2016 at www.hepcguidelines.org.au


Remote Consultation Request for Initiation of Hepatitis C Treatment

Developed by GESA- Australian Liver Association, this template can be used by medical practitioners, including general practitioners, to consult with a gastroenterologist, hepatologist, or infectious disease physician experienced in the treatment of chronic hepatitis C infection, in order to prescribe new treatments under the PBS. ​


Primary Care Consultation Request for Initiation of HCV Treatment in Victoria

This primary care consultation request form is to get authorisation to treat in Victoria. It has some significant differences to above GESA/ALA form, including:

    • referral to gastro and ID using the same form and same info
    • more emphasis on GP responsibility to check for drug interactions
    • no requirement to provide a list of current medications


New hepatitis C treatments factsheets listed on the PBS

See also the General Statement for Drugs for the Treatment of Hepatitis C to determine patient eligibility for subsidisation under the PBS for hepatitis C treating agents

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List of Community Medical Practitioners trained and experienced in the treatment of chronic hepatitis C infection.

View a list of Community Medical Practitioners trained and experienced in the treatment of chronic hepatitis C infection effective August 2016 here

 


Hepatitis C Education Program

​​​​ASHM is working to increase the capacity and confidence of primary care practitioners to diagnose, manage and treat people living with hepatitis C

ASHM receives funding from the Commonwealth Department of Health and Ageing to convene the National HCV Training Standards Committee which develops and endorses national curriculum and training materials and liaises with relevant state and territory jurisdictions for their implementation. 


Resources

There are a number of practical and clinical resources available to support your work with hepatitis C. These include the booklets GPs and Hepatitis C; Antenatal Testing and Blood-borne  Viruses; Nurses and Hepatitis C; and Dentists and Hepatitis C.

We have also produced a range of profession-based booklets for Emergency Services, Corrective Services Officers, Police Officers, as well as access to third-party resources and fact sheets for clients and patients. Please visit the resources page for the full catalogue.

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​References

1. Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance Report 2015.

2. Kirby Institute. Monitoring hepatitis C treatment uptake in Australia. August 2016.

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