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Chronic Hepatitis C disease - Key Points 

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  • Screening is indicated at least once in all persons aged over 18

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  • Order hepatitis C antibody. If positive, then order hepatitis C viral load (RNA) testing

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  • Hep C antibody (+) but Hep C viral load (-) = person was previously exposed to the hepatitis C virus but may or may not have an active infection.

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  • Hep C antibody (+) & Hep C viralload (+) = presence of the virus and active HCV infection

​WORK-UP​

  • Screen for Hep B (order HBsAg, anti-HBs, and anti-HBc) and HIV (HIV 4th generation).

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  • Order platelet count, INR, liver enzymes, BMP, and abdominal ultrasound

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  • Evaluate the extent of liver fibrosis related to Hepatitis C

    • Use of clinical scores (FIB-4 and APRI) and FibroScan

    • Liver biopsy is no longer recommended due to being an invasive test

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  • Abdominal ultrasound may not be necessary for all patients, though findings may suggest cirrhosis or discover tumors, nodules, or ascites.

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TREATMENT [high yield]

 

  • Glecaprevir (300 mg)/pibrentasvir (120 mg) for 8 weeks, or

  • Sofosbuvir (400 mg)/velpatasvir (100 mg) for 12 weeks

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