Quick reference guide
A quick reference guide illustrating recommended practices for managing hepatitis C infections with links to more detailed discussion of the research and evidence base.
Quick links on this page
Management of Hepatitis C
- Required testing
- Recommended testing
- Referral
- Treatment of acute HCV
- Treatment of chronic HCV
- Prevention of secondary transmision
Management of chronic HCV
Management of Hepatitis C
Required testing
The following groups should be tested for HCV:
- blood/tissue donors
- patients on haemodialysis
- healthcare workers who intend to pursue a career in a specialty that requires them to perform exposure prone procedures.
- healthcare workers at six, 12 and 24 weeks following an isolated acute percutaneous exposure to blood infected, or strongly suspected of being infected, with HCV, and anti-HCV testing at 12 and 24 weeks.
In children born to women infected with HCV, an HCV antibody test should be performed at 12 months of age or thereafter.
Recommended testing
Anyone with one of the following criteria should be offered an HCV test:
- an otherwise unexplained persistently elevated alanine aminotransferase
- a history of injecting drug use
- a child with an HCV antibody positive mother
- HIV positive
- recipient of blood clotting factor concentrates prior to 1987
- recipient of blood and blood components before September 1991 and organ/tissue transplants in the UK before 1992
- a healthcare worker following percutaneous or mucous membrane exposure to blood suspected to be/infected with HCV
- received medical/dental treatment in a country where HCV is common and infection control may be poor
- have had a tattoo or body piercing in circumstances where infection control procedure is suboptimal
- had a sexual partner/household contact who is HCV infected.
Referral
Patients with acute HCV infection should be referred to specialist care immediately.
Individuals, including injecting drug users, diagnosed with chronic HCV should be offered integrated multidisciplinary care.
Treatment of acute HCV
Patients with acute HCV infection which does not resolve spontaneously should start treatment between three and six months after diagnosis and receive IFN therapy for 24 weeks irrespective of genotype.
Treatment of chronic HCV
A combination of pegylated IFN and ribavirin is the treatment of choice for patients with hepatitis C.
Prevention of secondary transmision
- Advise individuals infected with HCV to avoid activities which could result in percutaneous or mucous membrane exposure to their infected blood, eg sharing razors or toothbrushes.
- Advise injecting drug users infected with HCV on how to prevent transmission of infection to other injecting drug users.
- Advise individuals co-infected with HIV/HCV to practise safe sex, using condoms.
- Healthcare workers who know they are HCV RNA positive should not undertake exposure prone procedures.
Knowledge of HCV RNA positive status should not influence obstetric management of pregnant women or standard advice regarding breast feeding.
Management of chronic hcv
Who to treat
There should be early consideration of antiviral therapy for patients with HCV with HIV co-infection.
Patients with CHC and HIV should receive treatment for 48 weeks irrespective of genotype.
In patients with HCV genotype 1 infection and HIV, the lack of an EVR at week 12 predicts absence of an SVR, and treatment can be stopped.
The following patient groups should all be considered for treatment with pegylated IFN and ribavirin:
patients with mild CHC
patients with chronic hepatitis C and normal ALT
patients with chronic hepatitis B and C co-infection
patients with CHC who are on a drug treatment programme
patients with stable mental health problems should not be excluded from treatment for CHC. Psychiatric symptoms should be monitored prior to and throughout IFN treatment
children with evidence of moderate or severe liver disease.
Nutrition
- Nutritional care for people infected with hepatitis C should involve promotion of optimal nutrition and prevention or treatment of malnutrition or deficiencies of specific nutrients.
- Patients should have a nutritional screen and if needed a nutritional assessment and appropriate advice by a dietitian.
