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Hepatitis C management simplification from test to cure: a framework for primary care physicians

Clinical Therapeutics
Available online 5 July 2018

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Hepatitis C Management Simplification From Test to Cure: A Framework for Primary Care Providers 

Shashi N. Kapadia, MD, MS; and Kristen M. Marks, MD, MS

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Weill Cornell Medicine, Division of Infectious Diseases, New York, New York

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Weill Cornell Medicine, Division of Infectious Diseases, New York, New York

Shashi N. Kapadia, MD, MS; and Kristen M. Marks, MD, MS

Abstract

This article proposes a strategy for primary care providers to begin treating patients with hepatitis C virus (HCV). We are motivated by the need to expand HCV treatment and by developments that have simplified treatment for most patients. This article presents 5 steps to achieving quality HCV treatment in the primary care setting: (1) accurate diagnosis via reflex testing; (2) risk stratification and identifying comorbidities via pretreatment evaluation; (3) simple, once-daily, pan-genotypic HCV treatment regimens; (4) minimized on-treatment monitoring: and (5) posttreatment monitoring and high-quality care for comorbidities such as cirrhosis and injection drug use. We provide indications for referral to specialists: notably children, patients with genotype 3 and cirrhosis, advanced liver or kidney disease, previous treatment failures, drug interactions with recommended regimens, and hepatitis B co-infection. Finally, potential barriers for providers are discussed, as well as further research findings and policy interventions that can promote HCV treatment in the primary care setting. We believe that a substantial portion of patients with HCV can be treated safely and effectively by nonspecialists and that the engagement of primary care providers is critical to efforts to end the HCV epidemic.

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