Summary

  • All people living with HCV should be considered for treatment.
  • Cure or Sustained Virological Response following treatment is associated with loss of infectivity, regression of liver fibrosis and cirrhosis and reduction in the risk of liver failure and HCC.

 

Hepatitis C Management in Australia

At the end of 2015, there were an estimated 227,306 people living in Australia with chronic hepatitis C infection, of whom 46,219 had severe fibrosis or hepatitis C related cirrhosis.1

Between 30,390 and 33,390 individuals initiated DAA treatment during March to December 2016.2

For details on hepatitis C treatment uptake in Australia since the PBS listing of new direct acting antivirals (DAAs) from 1 March 2016, access the Viral Hepatitis Clinical Research Program newsletters titled Monitoring hepatitis C treatment uptake in Australia.

 

GP Management Plan (GPMP) and Team Care Arrangements (TCAs) for HCV infection

To be eligible for a GP Management Plan (GPMP), the patient in Australia must have a chronic or terminal medical condition. To be eligible for Team Care Arrangements (TCAs), the patient must have a chronic or terminal medical condition that requires ongoing treatment from a multidisciplinary team.
 
ASHM has developed the GPMP and TCAs for HCV Infection to provide GPs with best practice guidelines in the management of HCV. While this GPMP specifically relates to management of HCV, patients’ other health problems and needs are also addressed. Recommended monitoring and review guidelines are included. 

Download here the 721 GP MANAGEMENT PLAN (GPMP) for HCV infection + 723 TEAM CARE ARRANGEMENTS (TCA)

 

Direct Acting Antiviral Treatment

Effective direct acting antiviral (DAA) treatment for hepatitis C is availa​ble. In the majority of cases, chronic hepatitis C can now be cured. All people living with HCV infection should be considered for treatment.

The HCV genotype must be documented in the patient’s history to meet PBS criteria for the new HCV medicines, therefore this must be determined prior to treatment initiation. ​

 

General Statement for Drugs for the Treatment of Hepatitis C

This general statement provides the prescriber and patient eligibility for subsidisation under the PBS for hepatitis C treating agents

The hepatitis C genotype determines the treatment regimens:

  • ​For genotype 1​ – sofosbuvir plus ledipasvir OR sofosbuvir plus daclatasvir ± ribavirin OR grazoprevir plus elbasvir ± ribavirin
  • For genotype 2 – sofosbuvir plus ribavirin
  • For genotype 3 – sofosbuvir plus daclatasvir OR sofosbuvir plus ribavirin
  • For genotype 4 – sofosbuvir plus PEG-IFN (and) ribavirin OR grazoprevir plus elbasvir ± ribavirin
  • For genotype 5-6 – sofosbuvir plus PEG-IFN (and) ribavirin

Length of treatment (usually 12 to 24 weeks) 

 

Australian recommendations for the management of hepatitis C virus infection: a consensus statement 2017

Prepared by an expert panel, this document provides guidance on epidemiology, models of care, diagnosis, pre-treatment assessment, monitoring and treatment. It is available in various formats:

 

Form: Remote Consultation Request for Initiation of Hepatitis C Treatment

Developed by GESA-Australian Liver Association, this template can be used by medical practitioners, including general practitioners, to consult with a gastroenterologist, hepatologist, or infectious disease physician experienced in the treatment of chronic hepatitis C infection, in order to prescribe new treatments under the PBS. ​

 

Form: Primary Care Consultation Request for Initiation of HCV Treatment in Victoria

This primary care consultation request form is to get authorisation to treat in Victoria. It has some significant differences to above GESA/ALA form, including:

  • referral to gastro and ID using the same form and same info
  • more emphasis on GP responsibility to check for drug interactions
  • no requirement to provide a list of current medications

 

Hepatitis C Education Program

ASHM supports medical practitioners in primary care to increase their knowledge and experience to enable them to prescribe treatment for hepatitis C independently. To find training near you see our Training Locator Map or for further information or support contact education@ashm.org.au

 

​References

  1. Kirby Institute. Annual Surveillance Report of HIV, viral hepatitis, STIs 2016
  2. Kirby Institute. Monitoring hepatitis C treatment uptake in Australia. February 2017