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 Viral Hepatitis Clinical Research Program newsletters titled Monitoring hepatitis C treatment uptake in Australia.

 

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

To be eligible for a GP Management Plan (GPMP), the patient in Australia must have a chronic or terminal medical condition. To be eligible for Team Care Arrangements (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. 

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

 

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. ​

 

General Statement for Drugs for the Treatment of Hepatitis C

This general statement provides the prescriber and patient eligibility for subsidisation under the PBS for hepatitis C treating agents

The hepatitis C genotype determines the treatment regimens:

  • ​For genotype 1​ – sofosbuvir plus ledipasvir OR sofosbuvir plus daclatasvir ± ribavirin OR grazoprevir plus elbasvir ± ribavirin
  • For genotype 2 – sofosbuvir plus ribavirin
  • For genotype 3 – sofosbuvir plus daclatasvir OR sofosbuvir plus ribavirin
  • For genotype 4 – sofosbuvir plus PEG-IFN (and) ribavirin OR grazoprevir plus elbasvir ± ribavirin
  • For genotype 5-6 – sofosbuvir plus PEG-IFN (and) ribavirin

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.

 

Australian recommendations for the management of hepatitis C virus infection: a consensus statement 2017

Prepared by an expert panel, this document provides guidance on epidemiology, models of care, diagnosis, pre-treatment assessment, monitoring and treatment. It is available in various formats:

 

Form: 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. ​

 

Form: 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

 

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. 

 

​References

  1. Kirby Institute. Annual Surveillance Report of HIV, viral hepatitis, STIs 2016
  2. Kirby Institute. Monitoring hepatitis C treatment uptake in Australia. August 2016