Download management protocol for hepatitis c patients not undergoing treatment

General Practice Gold Coast and Gold Coast Health Service District
Hepatitis C Shared Care Protocol
MANAGEMENT ADVICE FOR HEPATITIS C PATIENTS NOT
UNDERGOING TREATMENT
As part of an ongoing management and support plan for people with hepatitis C there
are a number of ways in which GPs can manage their patients irrespective of whether
they chose to undertake treatment or not.
These strategies have been divided into the following sections:
 Symptom management
 Diet
 Alcohol usage
 Other potential hepatotoxins
 Cigarette smoking
 Complementary therapies and herbal preparations
 Vaccinations
 Psycho-social considerations
 Referral and resources
 Ongoing tests and monitoring
Symptom management
People with hepatitis C who have never had hepatitis C treatment can experience a
broad range of symptoms that are not dissimilar from many other illnesses. Symptoms
attributed to hepatitis C include:
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Fatigue– both physical & mental
Irritability, including anger issues
Depression
Headache
Abdominal Pain
Nausea
Myalgia
Fever
Sleep disorder
Forgetfulness
Diet
Patients should be encouraged to eat a standard healthy diet. Nutritional supplements
are not necessary if diet is balanced, with a good intake of protein and fresh fruits and
vegetables.
Studies have shown that obesity increases liver damage. This occurs because there is
an association between obesity and steatosis (fat accumulation in liver cells). Steatosis
appears to cause more scar tissue and is more common with genotype 3 infection.
Weight reduction (diet and exercise) in overweight or obese people with HCV will
reduce hepatic steatosis and arrest or reverse liver fibrosis.
Alcohol Usage
Alcohol consumption increases hepatitis C virus replication. It also appears to
accelerate the progression of liver disease to cirrhosis
Reducing alcohol can improve liver enzymes and hepatitis C viral load. People with
HCV should consider drinking alcohol infrequently and well below levels for their
gender. Standard guidelines may be too much for patients with long-term infection
whose liver has not been assessed.
If the patient or their doctor has concerns about alcohol dependency, consider referral
to an alcohol & drug treatment service.
Other Potential Hepatotoxins
Iron accumulation is common in hepatitis C usually at the upper edge of normal
range. Some studies suggest that increased iron causes more scar tissue in HCV,
although the benefits of reducing mild overload are not clearly established.
Venesection is not recommended in the absence of haemochromatosis.
Cigarette smoking may increase fibrosis in people with hepatitis C. Preliminary data
suggests marijuana may also increase hepatic fibrosis and scarring. There is very little
data available regarding the effect of use of amphetamines, heroin, and ecstasy on
hepatitis C. Amphetamines and ecstasy are known to cause severe liver disease
although this is rare.
Complementary therapies & herbal preparations
St Mary’s Thistle is the most popular alternative therapy used by people with hepatitis
C. It has some anti-oxidant properties and studies have shown its use can lead to a
reduction of liver enzymes, although no loss of HCV virus. CH100 is an extract of 16
herbs. Controlled studies show improvements in liver enzymes, but no patients
cleared the virus. Liver biopsies were not repeated in these studies to assess effect on
the liver tissue.
Use of complementary therapies should be discussed with your liver specialist.
Additional advice can be sought through the Hepatitis Council of Queensland.
The National Prescribing Service Medicines Line is a phone service available to
consumers to enquire about the potential impact of medications (prescription, overthe-counter and complementary therapies) on patients with Hepatitis C.
Vaccination
There is no vaccine for hepatitis C. All patients with HCV should be offered HAV
and HBV vaccination if they are not immune to prevent further liver damage from
these infections.
Psychosocial considerations
Hepatitis C virus may occur in the setting of a lifestyle that involves a number of
potentially harmful behaviours including significant alcohol or drug use. Hepatitis C
is more prevalent in a number of marginalised communities including people with
mental illness, people who were born in areas of high endemicity and people who
have been incarcerated in prisons. People with HCV may therefore have a range of
psychosocial issues and may benefit from having these explored and addressed.
Referral and Resources
Some of the referral and resource options that can be discussed with hepatitis C
patients include:
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Hepatitis Council of Queensland – trained counselors (07) 3236 0612
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QUIHN 55 207 900 - Local drug user organization
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Drug or alcohol treatment service ATODS
o Northern end – Drug and Alcohol counseling 55 718 777
o Southern end – Opioid replacement program 55 769 020
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Specialist in Hepatitis C
o Public – Gold Coast Hosptial Liver Clinic
o Private – The Liver Centre
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Private Allied Health
o Psychiatrist or Psychologist
o Dietician
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National Prescribing Service Medicines Line – 1300 888 763
Complementary or alternative therapist experienced in hepatitis C
management
Ongoing tests and monitoring
LFTs and FBC every 6 months
Yearly ultrasound
Monitor signs and symptoms of liver disease
1
Clinical Pathways for Individuals with Hepatitis C on Treatment. Version 3
Hepatitis C Shared Care Resource Package. Queensland Health. Queensland
Government. 2007