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Patient Care Process: Management of Hepatitis C Infection



  • Patient characteristics (e.g., age, sex, weight, vital signs, etc.)

  • Patient history (past medical, family, social) and medical record summary including surgical operations (site, date, procedure) and abdominal imaging findings

  • Medication history (include prescription, nonprescription medications and other substances) and drug allergies and intolerances. Previous HCV therapy, if applicable.

  • Laboratory results for chronic HCV infection including HCV genotype and viral load (RNA) (Table 40-12)

  • Laboratory results for other viral infections impacting HCV treatment (HBV core antibody, HBV surface antigen, HBV surface antibody, HAV total or IgG antibody, HIV status)

  • Hemoglobin and hematocrit


  • Determine severity of underlying liver disease based on laboratory tests, clinical calculators (such as for the Child-Pugh Score for cirrhosis [Table 37-2]), imaging studies, and clinical history (Chapter 37, Clinical Presentation)

  • Estimate creatinine clearance to identify which HCV therapies may be used

  • Review patient-specific insurance company or healthcare payor formulary preferences and requirements for HCV therapy and determine if patient assistance programs may be utilized. Identify other potential obstacles to treatment success.

  • Determine if pre-treatment resistance testing is required

  • Check for drug interactions with prescribed medications, any non-prescription medications, herbal products, or dietary supplements


  • Establish the goal of therapy (e.g., eradicate HCV infection) with monitoring parameters for each goal (e.g., viral load). Consider efficacy and toxicity.

  • Based on HCV genotype, severity of underlying liver disease, renal function, and prior treatment experience, determine the appropriate therapy (based on the latest national guidelines) , treatment duration and monitoring plan (Table 40-13)

  • If ribavirin is part of therapy, review hemoglobin/hematocrit and need for supplemental iron, provide patient education to avoid pregnancy and prescription for contraception (if needed)


  • Initiate HCV anti-viral therapy according to plan.

  • Discontinue or modify adjunct medications if drug interactions anticipated with HCV antivirals

  • Assess patient for response to HCV antivirals (such as HCV RNA at treatment week 4)

  • Discuss with patient and patient's family strategies to avoid, identify and treat any potential adverse effects

  • Provide education to patient and care givers about drug therapies and emphasize adherence. Discuss with patient and patient's family strategies to minimize likelihood for drug therapy interruptions

Follow-up: Monitor and Evaluate

  • Continually reassess patient's use of HCV antivirals, any changes in other medications or herbals and supplements which could compromise HCV therapy, and any adverse effects

  • Monitor laboratories tests for response to antiviral therapy and changes in liver enzymes

  • Monitor for adherence and any interruptions in therapy which could risk the emergence of resistance and treatment failure

  • Evaluate patient for cure at least 12 weeks after completion of therapy and discuss implications of cure, HCV antibody positivity, and risks for reinfection

  • Reassess patient's risk for reinfection


For the chapter in the Wells Handbook, please go to Chapter 25. Hepatitis, Viral.



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