Hepatitis C Initial Visit
1. First, order a Viral load with reflex to genotype. 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): - CBC - Coags - CMP -HepC genotype - AFP (if cirrhotic) - Fibrotest Order - HIV (within 30 days) - Hep A/B antibody (within 30 days) and start Hepatitis Vaccination if due - Liver imaging (e.g. ultrasound) only if concern for cirrhosis - 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: o Varices o Ascites o Encephalopathy o Jaundice - 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 Jill Chen. If the patient does not meet criteria, then refer to GI HEP C clinic and still send Cerner message to Jill Chen.