Hep C Initial Visit Dot Phrase
1. First, order a Viral load if antibody positive. If Viral load present then proceed with labs and workup below.
2. If NO viral load detected, please discuss with an attending and do NOT workup.
If eligible based on above THEN order the following labs (within 12 weeks of initiating treatment):
- AFP (if cirrhotic)
- Fibrotest Order via Quest Flexitest
o Name: FibroTest-ActiTest Panel
o Test code: 92688
o 3.5 mL FROZEN
- HIV (within 30 days)
- Hep A/B antibody (within 30 days) or start Hepatitis Vaccination
- Urine drug screen (within 30 days)
Within the last 6 months:
- Abd U/S or CT
- Verify patient meets inclusion criteria:
- Fibrosis score 0-3 or 4 and compensated cirrhosis (Child-Pugh A)
- Have an active viral load
- Not have decompensated cirrhosis (Child-Pugh B/C). Decompensated cirrhosis is defined as:
- Be treatment naïve to novel HCV treatment (IFN/Ribavirin OK)
- Not have concurrent immune-modulating disorders such as tuberculosis or be on immunosuppressive therapies such as interferon, TNF alpha inhibitors, cyclosporine, etc. These patients should be seen by Hepatitis C clinic.
**If the patient also has HIV, these patients will be managed by Dr. Pawson and the resident. Please message Dr. Pawson.
Once labs are back, read inclusion criteria above. If pt meets above criteria, bring pt back for a Hep C treatment consultation visit with resident and a core faculty as well as sending a Cerner message to AFMC Case Manager Pool.
If the patient does not meet criteria, then refer to GI HEP C clinic and still send Cerner message to AFMC Case Manager Pool.