Hepatitis C summary

ASHM regional task force Covid 19

Hepatitis C summary

ASHM Regional Advisory Group interim HCV recommendations

 

Prepared by: Dr. Robert Batey, and members of the Taskforce and Regional Advisory Group viral hepatitis sub-groups

 

UPDATED ON: 17 June 2020

 

 

 

Disclaimer: The recommendations provided are the opinions of the authors and are not intended to provide a standard of care, or practice. This document does not reflect a systematic review of the evidence but will be revised to include relevant future systematic review findings. The recommendations are not intended to replace national guidance. 

 

Evidence is limited and emerging. Currently it appears that:

  • HCV does not affect COVID-19 outcomes  
  • Severe COVID is not more common in people with uncomplicated HCV 
  • Patients with HCV are expected to recover as well as other patients 
  • Patients with HCV should get the same high level of care for COVID, including hospital admission, oxygen, intensive care, ventilator support [link to our document]

People living with HCV who may be at increased risk of severe COVID:

  • Cirrhosis
  • Liver transplant with immunosuppression 

People with HCV without cirrhosis: defer HCV treatment and investigation if risk of secondary transmission is low
People with cirrhosis: treatment and investigation should continue as planned
Patients receiving HCV treatment: 

  • complete treatment. 
  • no treatment modification required
  • clinical follow-up may be deferred

Check vaccinations:  Influenza Pneumococcal 

Optimise health and comorbidities.

  • stop smoking
  • optimise hypertension and diabetes control
  • reduce alcohol
  • N.B. older age, obesity, cardiovascular disease, lung disease, cancer, and chronic liver disease (1)
  • do not stop or change angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blocker medications for high blood pressure (2)

Check Psychosocial status: connect patients to available services

  • Mental health
  • Drug and alcohol
  • Housing and security
  • Poverty
  • Food supply and security
  • Domestic violence

Connect with Community based organisations (CBOs)

  • CBOs and outreach workers can support clinicians to support patients

  • Support access to needle and syringe provision
  • Support access to opioid substitution therapy and improved flexibility of dosing (e.g. increase capacity for take away doses) (3)
  • Review overdose risk and safety, including provision of take-home naloxone where such service is available.

Adhere to measures that reduce COVID infection
Social/physical distancing: adhere to local guidelines

  • Patients with suspected COVID or TB should wear a mask
  • Regular hand washing
  • Refrain from touching the face 
  • Cough etiquette
  • Physical isolation of contacts & those with mild symptoms

  1. Hepatitis C Virus Infection Consensus Statement Working Group. Australian recommendations for the management of hepatitis C virus infection: a consensus statement (September 2018). Melbourne: Gastroenterological Society of Australia, 2018. https://www.asid.net.au/documents/item/1208
  2. Vaduganathan M, Vardeny O, Michel T, McMurray JJV, Pfeffer MA, Solomon SD. Renin-Angiotensin-Aldosterone System Inhibitors in Patients with Covid-19. N Engl J Med. 2020.
  3. Lintzeris N, Hayes V, Arunogiri S. Guidance for the Delivery of Medication Assisted Treatment of Opioid Dependence in Response to COVID-19: A National Response. RACP.2020