Hepatitis C

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Management

Get liver biopsy before treatment - it is the best predictor of disease progression, used in staging and helps assess response to treatment

Indications for treatment

  • Age>18
  • Detectable HCV RNA
  • Liver biopsy with bridging fibrosis and chronic hep.
  • Compensated liver disease (INR <1.5, Bili. <1.5, albu > 3.4

Contraindications for treatment

  • Ongoing alcohol or drug abuse
  • Major uncontrolled depression

Treatment

  • Initial therapy: peginterferon + ribavirin
  • Add telaprevir or boceprevir if HCV1
  • Vaccinate against HAV and HBV
  • No indication for barrier contraception in monogamous serodiscordant couples