Testing, Evaluation, and Monitoring of Hepatitis C
- For persons who might have been exposed to HCV within the past 6 months, testing for HCV RNA or follow-up testing for HCV antibody should be performed. For persons who are immunocompromised, testing for HCV RNA should be performed.
- To differentiate past, resolved HCV infection from biologic false positivity for HCV antibody, testing with another HCV-antibody assay can be considered. Repeat HCV-RNA testing if the person tested is suspected to have had HCV exposure within the past 6 months or has clinical evidence of HCV disease, or if there is concern regarding the handling or storage of the test specimen.
Adapted from Centers for Disease Control and Prevention (CDC, 2013).
Hepatitis C Fibrosis assessment:
Prior to treatment, it is important to have an understanding of disease progression and assess for cirrhosis. The following tools and guidance can be useful in making this determination:
- Calculate FIB-4 score
- Cirrhosis assessment: Liver biopsy is not required. For the purpose of this guidance, a patient is presumed to have cirrhosis if they have a FIB-4 score >3.25 or any of the following findings from a previously performed test.
- Transient elastography indicating cirrhosis (eg, FibroScan stiffness >12.5 kPa)
- Noninvasive serologic tests above proprietary cutoffs indicating cirrhosis (eg, FibroSure, Enhanced Liver Fibrosis Test, etc)
- Clinical evidence of cirrhosis (eg, liver nodularity and/or splenomegaly on imaging, platelet count <150,000/mm3, etc)
- Prior liver biopsy showing cirrhosis
Hepatitis C treatment:
In effort to expand the number of healthcare professionals who treat HCV, as well as simplify the treatment process, AASLD/IDSA HCV Treatment Guidance has developed a simplified treatment algorithm for both non-cirrhotic and cirrhotic patients:
- Simplified Treatment Algorithm for patients without cirrhosis
- Simplified Treatment Algorithm for patients with cirrhosis
Additional Resources for Hepatitis C treatment
- Link to for assessment of drug interactions to HCV therapy
- Comparison of hepatitis C treatment outcomes between telehepatology and specialty care clinics in the era of direct-acting antivirals
Michigan Department of Health and Human Services offers additional resources for Hepatitis C on the following sites.
- www.mi.gov/wetreathepc - This site gives comprehensive information on the MDHHS “ We Treat Hep C “ initiative
- https://www.michigan.gov/documents/mdhhs/FAQs_721635_7.pdf - This site give answers to frequently asked questions about the “We Treat Hep C “ initiative.
- www.mi.gov/hepatitis - gives general information and resources related to viral Hepatitis
- www.mi.gov/ssp - is a resource for information in Syringe Exchange Programs in the State of Michigan.