Australia is leading the world in treating our Hepatitis C population with the dual aims of treating people at risk of serious liver disease and reducing the population with disease enough to stop reinfection in our at-risk communities. We have done well to date, treating probably a third of Hepatitis C infected people.
We still have a way to go to fully achieve these aims. It is estimated there are still over 100,000 people with untreated Hep C in our communities and identifying and treating them is important. You can help.
Consider ordering Hep C for:
Hep C tests to order include Hep C serology (Hep C RNA and genotype if pos), E/LFT, FBC. If positive for Hep C RNA further tests required are in GESA Guidelines/Faxback form or GCUH referral template.
Any Hep C patient identified can be referred privately or to Hepatology at Gold Coast University Hospital (GCUH) or treated in community following Gastroenterological Society of Australia (GESA) guidelines if appropriate. GESA faxback can be sent to GCUH if you are comfortable treating yourself (07 Fax 5687 5097).
Another significant liver concern is Non-alcoholic fatty liver disease (NAFLD)/Non-alcoholic steaophepatits (NASH). As GESA guidelines have stated, it is not possible from routine liver tests or hepatic imaging to distinguish which patients with NAFLD have the more significant liver disease of NASH.
However, some factors associated with a higher probability of more advanced liver disease include:
If you have patients you are concerned may be at risk of fibrosis from NAFLD please consider further investigation or referral. Baseline clinical measurements and investigations would include:
Consideration of fibrosis calculator over time to monitor disease, such as FIB-4. Patients with a score above 2 should be referred for to hepatologist review/ fibroscan.
GCUH will accept NAFLD referral in the form of a letter preferable with the above information and can then arrange a fibroscan which can provide an estimated level of fibrosis. People with higher fibrosis F3 or cirrhosis F4 are obviously at increased risk for significant liver disease and liver clinic will advise on future monitoring.
Those with intermediate scores should still address lifestyle to reduce future risk. Please note the liver clinic is finding elastography and fibroscan are not always correlating well. If the patient can attend GCUH, fibroscan is thought to be a better predictor of fibrosis.
Liver disease is likely to be a leading cause of morbidity and mortality as our population becomes heavier and primary care providers will be at the forefront of care. This will be a challenge for our health system.
See the National Guidelines: Australian recommendations for the management of hepatitis C virus infection: a consense statement (September 2018)
This article was written by Dr Ingrid Francis, local Gold Coast GP and GP with Special Interest at GCUH.
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