Hepatitis C: Difference between revisions

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Adults with hepatitis C (any genotype) who do NOT have cirrhosis or have compensated cirrhosis (Child-Turcotte-Pugh (CTP) score < 6) and persons who have not previously received HCV treatment are eligible for simplified treatment pathway.


Patients who have any of the following are not eligible and need consultation with a liver disease specialist:
* Prior HCV treatment
* Current or prior episode of decompensated cirrhosis, defined as CTP score > 6 or presence of ascites, hepatic encephalopathy, total bilirubin > 2.0mg/dL, albumin < 3.5g/dL, or INR > 1.7
* HBsAg positive
* Current pregnancy
* Known or suspected hepatocellular carcinoma
* Prior liver transplantation
Step 1: Determine FIB-4 Score and Assess for Cirrhosis and proceed if FIB-4 < 3.25 without cirrhosis or CTP < 7 with cirrhosis.
Step 2: Pre-treatment Labs and Assessment.
{| class="wikitable"
!Lab
!How Recent?
|-
|If FIB-4 is indeterminate (1.45 – 3.25), Serum Fibrosis Test (FibroSure/Labcorp or FibroTest/Quest) or obtain FibroScan if test available (i.e. ANMC)
|Complete prior to choosing HCV medication – Fibrosis Interpretation
|-
|Pregnancy Test
|Immediately prior to treatment start and counsel about pregnancy risk with HCV medication
|-
|HCV RNA
|Acceptable within past 6 months
|-
|CBC (without diff)
|Acceptable within 3 months if cirrhosis, 6 months if no cirrhosis
|-
|Hepatic function panel
|Acceptable within past 6 months
|-
|Calculate Estimated Glomerular Filtration Rate (eGFR)
|Acceptable within past 6 months
|-
|AFP (only needed in cirrhosis)
|Acceptable within past 6 months
|-
|PT/INR (only needed in cirrhosis)
|Acceptable within 3 months
|-
|HCV genotype
|Only needed if patient has cirrhosis and will be treated with sofosbuvir/velpatasvir
|-
|HIV antigen/antibody
|Anytime prior
|-
|Hepatitis B surface antigen
|Anytime prior
|-
|Syphilis screening
|Anytime prior
|}
Step 3: Treat.
* Glecaprevir/Pibrentasvir (Mavyret™) 3 tablets daily x 8 weeks, or
* Sofosbuvir/Velpatasvir (Epclusa®) 1 tablet daily x 12 weeks
As decided by P&T committee April 24, 2019, all hepatitis C medications will be treated as an "open formulary.” 
Pharmacy will not routinely stock the medications, but will order in the medication when it is prescribed without a non-formulary request needing to be filled out. 
Some private insurances will require prior authorization.
===Resources/References===
===Resources/References===
*[http://dhss.alaska.gov/dhcs/Documents/pharmacy/forms/AK_Hep_C_DAA_Fax_Form_20171001.pdf Alaska Medicaid Prior Authorization Form Hepatitis C Direct Acting Antivirals – New Starts]
*Adapted from [https://anthc.org/community-health/wellness/#hep ANTHC Liver Disease and Hepatitis Program]
*American Association for the Study of Liver Diseases (AASLD) and Infectious Diseases Society of America (IDSA) [https://www.hcvguidelines.org/treatment-naive/simplified-treatment Simplified HCV Treatment for Treatment-Naive Adults Without Cirrhosis]
*AASLD and IDSA [https://www.hcvguidelines.org/treatment-naive/simplified-treatment-compensated-cirrhosis Simplified HCV Treatment Algorithm for Treatment-Naive Adults With Compensated Cirrhosis]
 
 
 
[[Practicing Medicine in Bush Alaska—Some ABCs|Common/Unique Medical Diagnoses]]

Latest revision as of 19:47, 16 September 2025

Adults with hepatitis C (any genotype) who do NOT have cirrhosis or have compensated cirrhosis (Child-Turcotte-Pugh (CTP) score < 6) and persons who have not previously received HCV treatment are eligible for simplified treatment pathway.

Patients who have any of the following are not eligible and need consultation with a liver disease specialist:

  • Prior HCV treatment
  • Current or prior episode of decompensated cirrhosis, defined as CTP score > 6 or presence of ascites, hepatic encephalopathy, total bilirubin > 2.0mg/dL, albumin < 3.5g/dL, or INR > 1.7
  • HBsAg positive
  • Current pregnancy
  • Known or suspected hepatocellular carcinoma
  • Prior liver transplantation

Step 1: Determine FIB-4 Score and Assess for Cirrhosis and proceed if FIB-4 < 3.25 without cirrhosis or CTP < 7 with cirrhosis.

Step 2: Pre-treatment Labs and Assessment.

Lab How Recent?
If FIB-4 is indeterminate (1.45 – 3.25), Serum Fibrosis Test (FibroSure/Labcorp or FibroTest/Quest) or obtain FibroScan if test available (i.e. ANMC) Complete prior to choosing HCV medication – Fibrosis Interpretation
Pregnancy Test Immediately prior to treatment start and counsel about pregnancy risk with HCV medication
HCV RNA Acceptable within past 6 months
CBC (without diff) Acceptable within 3 months if cirrhosis, 6 months if no cirrhosis
Hepatic function panel Acceptable within past 6 months
Calculate Estimated Glomerular Filtration Rate (eGFR) Acceptable within past 6 months
AFP (only needed in cirrhosis) Acceptable within past 6 months
PT/INR (only needed in cirrhosis) Acceptable within 3 months
HCV genotype Only needed if patient has cirrhosis and will be treated with sofosbuvir/velpatasvir
HIV antigen/antibody Anytime prior
Hepatitis B surface antigen Anytime prior
Syphilis screening Anytime prior

Step 3: Treat.

  • Glecaprevir/Pibrentasvir (Mavyret™) 3 tablets daily x 8 weeks, or
  • Sofosbuvir/Velpatasvir (Epclusa®) 1 tablet daily x 12 weeks

As decided by P&T committee April 24, 2019, all hepatitis C medications will be treated as an "open formulary.”

Pharmacy will not routinely stock the medications, but will order in the medication when it is prescribed without a non-formulary request needing to be filled out.

Some private insurances will require prior authorization.

Resources/References


Common/Unique Medical Diagnoses

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