What to Do With a Positive Hepatitis C Test

Extrahepatic manifestations of hepatitis C include:

• Hematologic (anemia, and lymphoma)

• Dermatologic (lichen planus and vasculitis)

• Renal (glomular nephritis and nephritic syndrome)

• Endocrine (hypothyroidism and diabetes)

• Neuropsychiatric disease

• Ocular (corneal ulcer and uveitis)

• Vascular (polyarteritis nodosa and necrotizing vasculitis)

• Neuromuscular (arthralgias and arthritis)

• Autoimmune (CREST syndrome) 


TRANSMISSION
Avoiding transmission to others is the best way to contain the spread of the infection. Advise individuals with hepatitis C to: avoid sharing toothbrushes, shaving equipment, razors, nail files, and clippers; avoid tattoos and body piercings; never donate blood, organ tissue, or semen; cover bleeding wounds to prevent contact with others; discontinue illicit drug use; never share needles. Because of the low sexual-transmission rate, barrier protection is not needed in monogamous relationships; otherwise, safe sex practices are warranted.

ALCOHOL AND HEPATITIS C

The effects of alcohol on hepatitis C are well documented. Alcohol consumption of greater than 50g per day clearly increases the progression of hepatitis C fibrosis. Daily consumption of less than 50g appears to increase hepatitis C PCR RNA viral load levels. 


TREATMENT ELIGIBILITY

The AASLD recommends that all patients with chronic hepatitis C be considered candidates for treatment. Review all risks and benefits with the patient. Treatment is based on histology, symptoms, probability of viral eradication, and progression of disease — not just the alanine aminotransferase levels. Treatment is contraindicated in patients with:

• Major uncontrolled depression

• Solid organ transplant (e.g., renal, heart, or lung)

• Autoimmune hepatitis and other autoimmune conditions that could be worsened by treatment

• Undiagnosed and untreated thyroid disease

• Pregnancy, unwillingness to comply with contraception

• Severe hypertension, congestive heart failure, coronary artery disease, diabetes, and chronic obstructive pulmonary disease that is not well controlled

• Hypersensitivity to any of the treatment medications (i.e., peginterferon alfa-2a [Pegasys] and alfa-2b [PEG-Intron], ribavirin [Copegus, Rebetol, RibaTab, Ribasphere], telaprevir [Incivek], Boceprevir [Victrelis]). 


WORK-UP

The initial work-up of hepatitis C should include a complete medical, family, and social history; depression scale; and laboratory testing (Table 1). With the advent of the protease inhibitors (PIs), liver biopsy is not required; however, if a patient is considering treatment and unsure whether to proceed, a biopsy can document what liver damage has occurred and determine the grade of inflammation and the stage of liver fibrosis.

Dental work must be completed prior to treatment. Vaccination for hepatitis A and B should be initiated and should not delay the start of treatment. 


This article originally appeared on Clinical Advisor