Updated guidelines for hepatitis C treatment include potential game-changers
12 August 2020
“Treatment of hepatitis C has never been easier,” said Professor Alex Thompson, Director of the Department of Gastroenterology at St Vincent’s Hospital Melbourne.
“The 2020 update to the Hepatitis C Consensus Statement highlights a number of important simplifications to the hepatitis C cascade of care, including the removal of the requirement for HCV genotype testing, the removal of an age threshold for access to DAA therapy meaning that children under 18 years can access treatment, updates to nurse practitioner prescribing, and the TGA approval of the first point of care assay for HCV RNA in Australia,” said Professor Alex Thompson, Director of the Department of Gastroenterology at St Vincent's Hospital, Melbourne.
“These changes will promote increased testing and treatment, critical for the achievement of hepatitis C elimination.”
The very positive developments include:
Prescribing by nurse practitioners
Prescribing rights have been extended to authorised nurse practitioners under the Highly Specialised Drugs Program, as well as the PBS General Schedule.
Increasing the number of professionals able to prescribe therapies, particularly for hepatitis C, may also increase the number of patients treated by making it easier to access treatment.
Removal of the PBS requirement to document HCV genotype before prescribing pan-genotypic treatment regimens for hepatitis C
The PBS General Statement for Drugs for the Treatment of Hepatitis C has been amended to remove the requirement for documenting HCV genotype to determine patient eligibility for subsidised hepatitis C treatment under the PBS. With well proven pan-genotypic medications now commonly used, this is one less barrier to getting patients onto treatment.
Removal of the PBS requirement that patients be aged 18 years or older before prescribing treatment for hepatitis C
Children under the age of 18 years can now be prescribed HCV treatment that is listed on the PBS.
Children under the age of 18 years should be referred to a paediatrician who is experienced in the treatment of HCV for discussion about therapy. A document providing specific guidance on the treatment of HCV infection in children aged under 18 years is in development.
TGA approves the first point-of-care assay for hepatitis C
The first point-of-care test for HCV RNA was approved by the Australian TGA in May 2020. The Xpert® HCV viral load assay measures HCV RNA from a finger-prick blood sample and provides a real-time result in approximately 60 - 90 minutes.
This testing option promotes screening for hepatitis C, as well as the development of “test-and-treat” models of care in high-risk populations. While there are a few practicalities to be resolved before it will be applied in practice, when fully available this will be a marked improvement.
More PBS-listed options for those who failed therapy with a regimen including an NS5A inhibitor
A new option for salvage therapy for people who have previously been unsuccessful with Direct Acting Antivirals was approved on the PBS last year. Patients in this category should be managed by an experienced physician or specialist. (See the consensus statement for further details).
Full details on the above, as well as other changes are available in the Australian recommendations for the management of hepatitis C virus infection: a consensus statement (June 2020).
Access the resources:
The consensus statement has been prepared by an expert panel representing the Gastroenterological Society of Australia (Liver Faculty), the Australasian Society for Infectious Diseases, the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine, the Australasian Hepatology Association, Hepatitis Australia and the Royal Australian College of General Practitioners.