Hepatitis C infection – the coming revolution

Special Guest post from Dr Joshua Davis, Senior Staff Specialist Infectious Diseases:

We are on the cusp of a revolution in the way we treat Hepatitis C Virus (HCV) infection. HCV matters, as it is common (about 1.5% of Australian adults are infected), and 20-30% of those infected end up with cirrhosis or liver cancer as a result.

The current standard treatment is based on weekly interferon injections (combined with oral ribavirin) and no one wants it! It involves 24-48 weeks of treatment, with many severe side effects, and an approximately 45% overall chance of cure. As a result, only abut 1% of Australia’s 220,000 people living with HCV are currently treated each year. A number of new, direct acting antivirals are now TGA approved for treating HCV infection. These are all-oral regimens, generally for 12 weeks only, with very few adverse effects and 90-95% cure rates. Once these become PBS funded (we anticipate this will be in early 2016), there is likely to be a huge upsurge in demand for treatment, which will be great for public health (it will be theoretically possible to eliminate HCV from Australia), but will overwhelm the capacity of current liver clinics.

Hence GPs will be a vital part of this revolution. Initially in ensuring all those with risk factors are tested and referring all those who are infected (HCV PCR positive) for treatment. And over the next couple of years, it is likely that HCV treatment will become predominantly done in community settings (general practice, sexual health clinics, needle exchanges etc), so GPs with an interest will be able to be trained and certified in HCV prescribing.

Key things to remember in the meantime:

1) Offer HCV serology to all those with a history of IV drug use (ever), blood transfusion before 1994, non-professional tattoos or piercings, medical procedures overseas, unexplained raised LFTs, or any who request it!

2) In those with positive serology, about 25% will have cleared the virus spontaneously and be no longer infected. Hence all should be tested for ongoing infection by HCV PCR

3) Those who are infected with HCV (already known or newly discovered) should be told that safe and effective treatment will soon be available to all, and that the vast majority of those treated will be cured.

4) Prior to referring to a viral hepatitis treatment service (e.g. JHH viral hepatitis service), please check HCV genotype, LFTs, a baseline ultrasound and serology for HAV, HBV and HIV.

Further information on Hepatitis C treatment is available from The American Association for the Study of Liver Diseases.

A future post will explain details of the new drug regimens.

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