Chronic hepatitis C: Diagnosis and treatment made easy

Abstract

Background Hepatitis C Virus (HCV) is a common cause of chronic liver disease and its ensuing complications. In the last years, there has been a revolution of the treatment for patients with HCV regarding efficacy, simplicity, safety and duration of treatment. The role of the family physician is vital in all steps of care: screening, diagnosis, linkage to treatment, treatment and follow-up. Objectives This review aims to summarise the family physician and the important updated recommendations for diagnosis and treatment of patients with chronic HCV. Methods The updated recommendations were reviewed and summarised in a short and simple review. Results Patients with any risk factor for HCV should first be screened for HCV antibodies. In the case of positive antibodies, reflex testing for RNA polymerase chain reaction (PCR) should be done without waiting for genotype. For patients with positive PCR, fibrosis assessment should be conducted using laboratory panels (Fibrosis-4 index (FIB-4) or aspartate aminotransferase to platelet ratio index (APRI)); if advanced fibrosis is suspected, additional non-invasive fibrosis assessment is needed, such as fibrotest or liver elastography. Naïve non-cirrhotic or compensated cirrhosis (Child-Pugh-Score A) could be treated with pangenotypic drugs, Glecaprevir/pibrentasvir (Maviret) for eight weeks, or Sofosbuvir/velpatasvir (Epclusa) for 12 weeks. Conclusion Patients without advanced fibrosis and comorbidities can be treated by the educated family physician. However, patients with comorbidities, cirrhosis or coinfection (HIV, Hepatitis B Virus (HBV)) should be referred to the liver clinic. In case of screening patients with risk factors or likelihood of dormant HCV, health organisations should provide the appropriate resources, logistics, finances and workforce.

Hepatitis C Elimination: Opportunities and Challenges in 2023

“…The following at-risk populations should be invited for HCV antibody testing: intravenous drug users, pre-1992 blood transfusion recipients, pre-1992 organ transplant recipients, pre-1987 clotting factor concentrate recipients, infants born to HCV viremic mothers, hemodialysis patients, HIV-positive cases, men who have sex with men, and migrants from a country with high HCV prevalence [ 16 , 17 , 18 ]. Special considerations are necessary for PWIDs and prisoners [ 2 , 16 , 17 , 18 ].…”

“…The process starts with screening, continues to diagnosis and treatment, and proceeds with follow-up. Family doctors may prescribe DAA to treat HCV patients with a low fibrosis grade [ 2 ] and forego unnecessary consultations with gastroenterologists or hepatologists, thus expediting the time from diagnosis to treatment. Nevertheless, there are several barriers at the level of family doctors.…”

“…During the last decade, diagnosis and treatment have been simplified. The old process included a lot of laboratory testing during the treatment, treatment with significant side effects, and a low rate of sustained virologic response (SVR) [ 1 , 2 , 3 , 4 ].…”

“…Direct-acting antiviral medications cure the infection in most cases, and the treatment with oral DAAs is highly effective with minimal adverse effects [ 2 , 3 , 4 ]. Chronic HCV infection involves a long-term inflammatory process.…”

Liver Fibrosis Regression and Associated Factors in HCV Patients Treated with Direct-Acting Antiviral Agents

“…The development of direct-acting antiviral agents (DAAs) and transition to interferon-free oral treatment with high efficacy and a low rate of adverse events revolutionized the treatment of HCV. This was primarily due to the high efficacy rate, simplified treatment regimens, and the ability of general practitioners to prescribe and treat HCV [ 2 ]. Curing the HCV infection is the primary goal of current treatment; achieving a sustained virological response (SVR) leads to normalization of the liver enzymes and resolution of the necroinflammatory process and liver fibrosis regression, resulting in improvements in liver function [ 3 , 4 , 5 ].…”