WA News Letters Making Hep C History
Making Hep C History
Written by Dr Donna Mak
Wednesday, 25 January 2017

Dear Editor,

Do your bit to make hep C history by making a new year’s resolution to cure your patients with chronic hepatitis C.

Despite highly effective, well-tolerated, oral anti-viral treatments for hepatitis C being available on PBS since March 2016, WA is still lagging behind other states in terms of treatment uptake with only 7% of patients with chronic hepatitis C having been started on treatment, in contrast with 19% in the ACT and 11-13% in NSW, Qld, SA and Vic.

Remember that most patients with chronic hepatitis C are asymptomatic until they develop advanced liver disease. Therefore it is important to be proactive about offering hepatitis C testing to people who have current or past risk factors for chronic hepatitis C, e.g. current or past IV drug use, born in a high prevalence area (i.e. Africa, and Central and East Asia), imprisonment.

Inform your patients that directly active antiviral treatments have cure rates of 90-95% after 8-12 weeks treatment, and are oral and well-tolerated – no interferon injections required.

Upskill yourself. There are many free training opportunities – online (https://lms.ashm.org.au/; www.nps.org.au/health-professionals/cpd/activities/online-courses/managing-hepatitis-c-in-primary-care; http://hepatitis.ecu.edu.au/) and face-to-face seminars (contact This e-mail address is being protected from spambots. You need JavaScript enabled to view it )

GPs can now initiate PBS-funded S85 hepatitis C treatments without specialist authorisation. Patients must be treated by a medical practitioner experienced in the treatment of chronic hepatitis C infection; or in consultation with a gastroenterologist, hepatologist or infectious diseases physician experienced in the treatment of chronic hepatitis C infection.

For more information about how to prescribe, see The Silver Book (Guidelines for managing STI and BBVs www.health.wa.gov.au/Silver-book)

Prof Donna Mak, Communicable Disease Control Directorate, WA Health

ED: We received a TGA warning that “direct-acting antiviral (DAA) medicines for the treatment of chronic hepatitis C virus (HCV) infection have been associated with reactivation of hepatitis B virus (HBV) in patients with a current or previous HBV infection. Reactivation of HBV can cause serious liver problems, including hepatitis, liver failure and in rare cases death.” When we asked Prof Mak about this she said those co-infected with hep B and C would normally be referred for specialist consultation by their treating GP, they made up a very small percentage of the many untreated people, and that as testing for hep B and HIV are in the routine protocols for working-up a patient for hep C treatment, the situation was taken care of. The TGA is working with sponsors of the seven DAA medicines currently available in Australia to update their Product Information to contain warnings about HBV reactivation.

he TGA website goes on to say: If you are currently treating patients for chronic HCV infection with DAA medicines, advise them of this issue and screen for evidence of HBV infection, including testing for HBV surface antigen (HBsAg) and HBV core antibody (anti-HBc). It is important to be aware that reactivation of HBV can occur in patients with serologic evidence of past infection (HBsAg negative and anti-HBc positive). HBV reactivation is diagnosed when there is an abrupt, marked increase in serum HBV DNA level, and may be accompanied by hepatitis ranging from mild to severe. Patients with HCV-HBV co-infection should be cared for by a clinician experienced in managing both conditions. For patients with no serologic evidence of current or past HBV infection, consider vaccination against HBV.