Hepatitis C

Hepatitis C virus (HCV)

Patients with HCV infection are managed by the Gastroenterology team at BGH.

Treatment of HCV is well tolerated and highly effective; almost 100% of infections are cured by tablets taken once daily for 8-12 weeks. All patients with evidence of active HCV infection should be referred for consideration of antiviral treatment. Where appropriate, patients with cirrhosis will be offered enrolment into HCC surveillance, consisting of 6 monthly liver ultrasound and serum AFP measurement.

Testing:

Hepatitis C antibody testing is performed as the initial screening test (4.9mL brown capped gel tube). If the patient is already known to be HCV antibody positive, please send HCV RNA quantitative PCR to confirm active infection (9mL (or 2 x 2.6mL) red cap EDTA tubes).

The lab will reflexively test HCV PCR on all new HCV antibody positive samples.

HCV antibody does not confer immunity to subsequent infection; HCV antibody positive and PCR negative patients should be counselled regarding risk factors for re-infection and offered regular screening with HCV PCR if there is ongoing exposure.

Who to refer, who not to refer, how to refer

Who to refer:

All those with evidence of active HCV infection (HCV PCR positive) should be referred for consideration of antiviral treatment.

Patients with both HIV and HCV should be referred to both gastroenterology and to sexual health.

Who not to refer:

Those who are hepatitis C antibody positive and HCV PCR negative (this indicates past infection). However, consider repeat testing if there has been a potential exposure in the 2 weeks preceding HCV PCR testing, and offer regular testing if the patient is at ongoing risk of BBV acquisition.

How to refer:

Gastroenterology at Borders General Hospital

GP teams should refer via SCI Gateway:

Borders General Hospital -> Gastroenterology -> Borders General Referral

Nurse led outreach clinics

Patients may be followed up in nurse led clinics for their ongoing treatment. These are not for direct referral.

Primary care management

Patients should be offered screening for HIV and HBV infection.

All patients with HCV should be offered or referred for a course of HBV vaccine unless known to be immune/infected (people living with HIV will be offered this at the treatment centre).

All patients with HCV should be given general lifestyle advice, including advice on minimising/stopping alcohol, and weight reduction/healthy eating advice if BMI >25.

Any patient with active HCV infection should be encouraged to attend a treatment clinic. Even if they are not currently wanting treatment they will be seen for monitoring and support.

Patients with chronic hepatitis who do not wish to be referred / do not attend are at risk of complications of cirrhosis / cancer and need to be aware of this. They should be strongly encouraged to accept referral to secondary care and every opportunity taken to prompt this and check LFTs if they present again. Please note that patients with an AST/ALT ratio greater than 1 are at risk of complications of cirrhosis.

If appropriate, patients with cirrhosis should be offered enrolment into HCC surveillance, consisting of 6 monthly liver ultrasound and serum AFP measurement, this is arranged through the gastroenterology team.

Resources and links

Hepatitis C - British Liver Trust

Local service contact details

bor.gastroenterology@borders.scot.nhs.uk