Hepatitis C
Overview
- Sexual transmission is rare but can occur in men who have sex with men (MSM), particularly those with HIV.
- Hepatitis C can cause acute hepatitis (uncommon), chronic hepatitis C (longer than 6 months, 75%) or spontaneously clear (25%).
- Disease progression is usually slow but may cause cirrhosis, liver failure and hepatocellular carcinoma.
- Disease progression can be affected by age at infection, duration of infection, heavy alcohol intake, coinfection with HIV or HBV, male gender, stage of fibrosis and higher ALT levels.
- Almost all patients can be successfully treated with DAA (directly acting antiviral) therapy.
Cause
Infection with the single-stranded RNA hepatitis C virus.
Clinical presentation
Symptoms |
Asymptomatic infection: common |
Acute hepatitis: uncommon. Symptoms such as lethargy, nausea, fever, anorexia for a few days then jaundice, pale stools and dark urine |
Chronic hepatitis: infection lasting over 6 months, can be life-long, may cause extra-hepatic manifestations such as skin or joint symptoms |
Complications |
Cirrhosis: ankle swelling, ascites, gastrointestinal bleeding, encephalopathy, jaundice |
Hepatocellular carcinoma: abdominal mass |
Diagnosis
Decision making tool for hepatitis C
Test | Site/Specimen | Consideration |
---|---|---|
Hep C Ab | Blood |
Infection with hepatitis C (past or current) |
HCV RNA (NAAT)/HCV PCR | Blood |
Positive indicates current/active HCV infection. Negative indicates past/cleared HCV (should be repeated). |
LFT | Blood |
Raised ALT, AST indicate hepatitis |
HCV quantitative NAAT | Blood | May be performed in primary care or by specialist |
HCV genotype | Blood | May be performed in primary care or by specialist, genotype determines treatment regimen and duration of therapy |
HCV – Hepatitis C virus Hep C Ab – Hepatitis C antibody RNA – Ribonucleic acid NAAT – Nucleic Acid Amplification Test PCR – Polymerase chain reaction LFT – Liver function test ALT – Alanine aminotransferase AST – Aspartate aminotransferase |
- About 75% will progress to chronic hepatitis.
- Past cleared hepatitis C infection does not provide immunity to reinfection.
- Medicare Benefits Schedule (MBS) allows 1 HCV RNA qualitative test annually for patients who are Hep C Ab positive or where the results are indeterminate, the patient is immunosuppressed or before seroconversion if necessary for clinical management. A maximum of 4 HCV RNA quantitative RNA tests are allowed on the MBS for patients undertaking treatment.
Management
Management Options | ||
---|---|---|
Situation | Recommended | Alternative |
Acute hepatitis |
Consider urgent referral for possible treatment |
Observation as some patients will clear hepatitis C. |
Chronic infection |
Direct-acting antiviral drugs offer curative treatment in over 95% of patients. |
Observation if other comorbidities require management/stabilising. |
Complications |
Referral to specialist if complications suspected e.g. cirrhosis. |
n/a |
HCV – Hepatitis C virus |
Treatment advice
- Offer treatment to all patients
- Work-up and treatment initiation in collaboration with authorised HCV treatment providers.
Other immediate management
- No significant risk of sexual transmission except for HIV positive men
- Vaccinate for hepatitis A and B, if susceptible
- Consider comprehensive other STI testing, depending on the patient’s sexual history
- Provide patient with fact sheet
- Notify the state/territory health department if required.
Special treatment situations
Situation | Recommended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Pregnant women
For more information go to the Therapeutic Goods Association's Prescribing medicines in pregnancy database and/or seek specialist advice. ![]() |
All babies should have close follow-up, including testing for Hep C Ab and HCV RNA at 18 months of age. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
HCV – Hepatitis C virus |
Contact tracing
- Low risk for sexual exposure (except for HIV positive men) so contact tracing not generally performed for sexual partners.
- Contacts via parenteral exposure (shared needles, injecting equipment) should be tested if possible.
- Children of mothers who are hepatitis C positive should be tested.
See Australasian Contract Tracing Manual - Hepatitis C for more information.
Follow up
Patients with chronic hepatitis C should be assessed for other causes of hepatitis (e.g. alcohol, fatty liver), and should be counselled to reduce these factors if relevant (e.g. reduced alcohol intake).
Test of Cure (TOC)
Following successful treatment or natural clearance of hepatitis C, HCV RNA will be negative although hepatitis C antibody will remain positive.
Retesting
Clearance of hepatitis C does not provide immunity from reinfection. Retesting is required if there is a continued risk of re-exposure.
Auditable outcomes
- 100% of hepatitis C antibody positive patients should have hepatitis C RNA performed.
- 100% of hepatitis C antibody positive/RNA positive patients should be offered HCV treatment.