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KEY CONCEPTS

KEY CONCEPTS

  • image Hepatitis A virus (HAV) is transmitted via the fecal–oral route, most often from ingestion of contaminated food or water, or through contact with an infected person.

  • image HAV causes an acute, self-limiting illness and does not lead to chronic infection. There are three stages of infection: incubation, acute hepatitis, and convalescence. Rarely, the infection progresses to liver failure.

  • image HAV is vaccine preventable. There is no pharmacological treatment specifically for HAV as treatment consists of supportive care.

  • image Hepatitis B virus (HBV) causes both acute and chronic infection. Chronic infections are responsible for high rates of liver disease, liver cancer, and death.

  • image Vaccination can prevent HBV and is the most effective strategy in preventing complications of HBV infections. Prevention of HBV infections focuses on immunization of all children and at-risk adults.

  • image The purpose of anti-HBV drug therapy is for viral suppression and immune control and to prevent progression of liver disease and the complications associated with HBV infections.

  • image Initial therapy of chronic HBV is with tenofovir or entecavir because these agents have a high barrier to resistance. Therapy is often long term.

  • image Patients undergoing immunosuppressive therapy or chemotherapy should be screened for HBV infections and may require HBV therapy to reduce the risks of reactivating their HBV and developing fulminant liver failure.

  • image The hepatitis C virus (HCV) is an insidious, blood-borne infection. Increased screening of all patients born between 1945 and 1965 was implemented to help identify the many people unaware of their infection.

  • image Hepatitis C infections can cause significant morbidity (including extrahepatic manifestations) and mortality. Patients with chronic hepatitis C are at risk for end-stage liver disease, cirrhosis, liver transplant, and death as a result of their infection.

  • image The goal of anti-hepatitis C virus (HCV) drug treatment is cure. Drug therapy with direct-acting antivirals (DAAs) is highly effective and well tolerated.

PATIENT CARE PROCESS

Patient Care Process for Hepatitis C

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Collect

  • Patient characteristics (eg, 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

  • Thorough 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)

  • 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)

Assess

  • Determine severity of underlying liver disease based on laboratory tests, clinical calculators, imaging, and clinical history

  • If the patient has cirrhosis, assess the level of liver dysfunction using the Child-Pugh Score to determine options for HCV therapy

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

  • Review insurance company formulary preferences for HCV therapy

  • Review national guidelines for updated treatment recommendations

  • Assess if patient assistance programs may be utilized

  • Determine if pretreatment resistance testing is required

Plan*

  • Determine goals of therapy with ...

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