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New Australian recommendations for Hep C management

New Australian recommendations for the management of hepatitis C virus (HCV) infection have been released in a consensus statement, with a summary published online by the Medical Journal of Australia.

The consensus statement was drawn up by the Gastroenterological Society of Australia, the Australasian Society of Infectious Diseases, the Australasian Hepatology Association, the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine, Hepatitis Australia and the Royal Australian College of General Practitioners.

Professor Alexander Thompson, director of gastroenterology at St Vincent’s Hospital in Melbourne and author of the MJA summary, wrote that the timing was right for the new recommendations in the wake of the listing of several direct-acting antiviral (DAA) therapies for HCV by the Pharmaceutical Benefits Scheme earlier this month.

“The introduction of DAA therapies for HCV that are highly effective and well tolerated is a major medical advance,” Professor Thompson wrote. “All Australians living with HCV should now be considered for antiviral therapy.”

Other recommendations in the consensus statement:

  • All individuals with a risk factor for HCV infection should be tested;
  • Annual HCV serological testing is recommended for seronegative individuals with risk factors for HCV transmission;
  • People with confirmed HCV infection should be tested for HCV genotype (Gt);
  • All concomitant medications should be reviewed before starting treatment, using the University of Liverpool’s Hepatitis Drug Interactions website;
  • The use of any DAA regimen during pregnancy is not recommended;
  • People who are not cured by a first-line interferon-free treatment regimen should be referred to a specialist centre;
  • All people with decompensated liver disease, extra-hepatic manifestations of HCV, HCV-HIV or HCV-HBV co-infection, renal impairment or acute HCV infection, as well as people who have had a liver transplant should be referred for management by a specialist who is experienced in the relevant areas.
  • All people living with HCV infection should have a liver fibrosis assessment before treatment to evaluate for the presence of cirrhosis
  • People with no cirrhosis can be treated by general practitioners working in consultation with specialists