Which specialist consultations are required for the management of hepatitis C (hep C) infection?

Updated: Oct 07, 2019
  • Author: Vinod K Dhawan, MD, FACP, FRCPC, FIDSA; Chief Editor: BS Anand, MD  more...
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Answer

Consultations

Consultation with a gastroenterologist and hepatologist is recommended in the treatment of hepatitis C virus (HCV) infection. Consultation with a psychiatrist may be helpful before and during treatment in patients at risk of depression or other psychiatric illnesses. Patients with cirrhosis should be referred for liver transplantation evaluation after decompensation or when their Model for End-Stage Liver Disease (MELD) score rises.

Long-term monitoring

AASLD/ISDA guidelines

For patients who achieved a sustained virologic response (SVR), the AASLD/ISDA recommendations are as follows [9] :

  • Those without advanced fibrosis (ie, Metavir stage F0, F1, or F2): Follow up as in never-infected individuals.
  • Those with ongoing risk for HCV infection or when otherwise unexplained hepatic dysfunction develops: Assess for HCV recurrence or reinfection with a quantitative HCV RNA test rather than an HCV-antibody test
  • Those with advanced fibrosis (ie, Metavir stage F3 or F4): Surveil for hepatocelluar carcinoma (HCC) with twice-yearly ultrasonography.
  • Those with cirrhosis: Obtain baseline endoscopy to screen for varices; if found, treat and follow up as indicated.
  • Those with persistently abnormal liver studies: Evaluate for other causes of liver disease.

For patients with posttreatment failure to achieve an SVR [9] :

  • Assess for disease progression every 6-12 months with hepatic function studies, complete blood cell (CBC) count, and international normalized ratio (INR).
  • In those with advanced fibrosis (ie, Metavir stage F3 or F4), screen for HCC with ultrasonography every 6 months.
  • In those with cirrhosis, obtain endoscopy screening for varices.
  • Evaluate for retreatment as effective alternative therapies become available.

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