Hepatitis C Testing and Treatment in RQHR

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Hepatitis C Testing and Treatment in RQHR

26-Oct-2017

Treatment for Hepatitis C has changed dramatically over the course of the past several years.

Nearly all individuals have access to highly-effective, once-daily, oral direct-acting antiviral medications with cure rates exceeding 95% in most populations. These medications are simple, very well-tolerated, and extremely effective. As access to these medications improves, it becomes increasingly important for us to work together to cure all persons infected with Hepatitis C.

Three key components that medical practitioners have direct impact on are:

  1. Increased testing.
  2. Increased referral to specialist providers for treatment.
  3. Learning to provide treatment to their own patients.

To this end, we are providing an update regarding testing recommendations, and referral processes.

Hepatitis C testing is recommended for:

  • Anyone born in Canada between 1945-19751.
  • Individuals with current or past history of injection drug use
  • Individuals who have been incarcerated
  • Individuals who were born, travelled or resided in HCV endemic countries
  • Individuals who have received health care where there is a lack of universal precautions
  • Recipients of blood transfusions, blood products or organ transplant before 1992 in Canada
  • Hemodialysis patients
  • Individuals who have had needle stick injuries
  • Individuals who have engaged in other risks sometimes associated with HCV exposure such ashigh-risk sexual behaviours, homelessness, intranasal and inhalation drug use, tattooing, body piercing or sharing sharp instruments or personal hygiene materials with someone who is HCV positive
  • Anyone with clinical clues suspicious for HCV infection (and above risk factors)

1 Canadian Liver Foundation, June 2016.

Interpretation of Results, and Follow-up Action

A negative Hepatitis C antibody test must be interpreted in the context of a 3 month window period. If the patient has had risk of exposure within the past 3 months, re-testing is recommended at the end of the window period, or on a regular basis if exposure is on-going.

A positive Hepatitis C antibody test means the patient has been exposed to Hepatitis C virus at some point, but does not necessarily mean that the patient is still viremic with Hepatitis C. Some patients clear HCV viremia spontaneously. This usually happens within the first 6 months after the person is infected. Patients can also be treated successfully and cure their HCV.

A reactive Hepatitis C antigen test means that the patient has active Hepatitis C infection. An HCV viral load (PCR) and genotype test should be submitted.

A non-reactive Hepatitis C antigen test means that the patient has either successfully cleared the virus either through treatment or spontaneously clearance, or they may have low-level HCV viremia. An HCV viral load (PCR) and genotype test should be submitted to ensure the patient does not have low-level viremia which requires treatment.

A Hepatitis C viral load (PCR) test checks the amount of Hepatitis C virus a patient has in their blood. If the value is ‘Target Not Detected’ or ‘<12’, that means that the patient has cleared their virus spontaneously (if they have never been treated), or it may mean they have successfully cured (if they have been treated).

A Hepatitis C genotype tells us which type of Hepatitis C a person has. This allows determination of the most appropriate type of work-up and treatment required for that patient.

Referral for Treatment

Nearly ALL patients can be treated and cured of Hepatitis C.

Public funding of Direct-Acting Antiviral (DAA) therapy in Canada is anticipated to be open to all individuals in 2018.

Treatment consists of oral medications for 8 to 12 weeks for nearly all patients.

The new DAA therapies are very well-tolerated with few side effects.

Send a referral to one of the treatment providers listed below. Ideally, order further lab investigations if they have not recently been done, and copy these results to the treatment provider to whom you will be referring your patient to. The following tests are suggested:

  • Hepatitis C viral load
  • Hepatitis C genotype
  • HIV serology
  • Hepatitis B surface antigen / surface antibody
  • Hepatitis A total antibody (IgG)
  • CBC & diff, renal panel, liver panel (ALT, AST, total bilirubin, alkaline phosphatase, albumin), INR/PTT

 

HCV Treatment Provider Contact Information 

4E - ID Clinic, Regina General Hospital
1440-14th Avenue
Regina, Saskatchewan, Canada
S4P 0W5

Dr. K. Karunakaran
Dr. S. Skinner
Dr. A. Wong

Referrals can be faxed to 306-766-3995.

The ID Clinic team will perform the appropriate medical work-up, see the patient, and discuss and arrange treatment for your patients.

If you have specific questions regarding your patients or the appropriate work-up required, please call Dennaye Fuchs, RN at 306-766-4521. 

Dr. Harris, Outpost ClinicPam Ford, RN at (c) 306-531-6748
Dr. McHattie 1821 Rose St.
Dr. Ali
Dr. Chami
Dr. O’Byrne
Dr. Ukabam
Fax 306-359-1068 

 

Thank you for your assistance in helping us to eliminate HCV in the province of Saskatchewan. Please contact us if you have any further questions.

Submitted by: Dr. M. Hennink, Deputy Medical Health Officer