Structured care process in chronic hepatitis B and C infections that includes monitoring of liver function, measurement of viral load, and administration of antiviral therapy.
Indication
- Patients found to have chronic hepatitis B (HBsAg positivity)
- Patients found to have chronic hepatitis C (HCV RNA positivity)
- Persistent elevation of liver enzymes (ALT/AST)
- Patients found to have advanced fibrosis on liver biopsy or elastography
- Individuals at risk of cirrhosis or liver cancer due to hepatitis virus
- Follow-up of infants born to hepatitis B carrier mothers
- Reactivation risk assessment in patients who will receive immunosuppressive therapy
Preparation
- At the initial assessment, complete blood count, liver function tests, and viral load (HBV-DNA / HCV-RNA) are measured
- The level of fibrosis is assessed with liver ultrasound and elastography (FibroScan)
- Viral genotyping is performed before hepatitis C treatment
- Pregnancy status and other concurrent medications should be reported to the physician before starting treatment
- Vaccination status (hepatitis A) is reviewed
How it's performed
- In hepatitis B, oral antivirals (entecavir, tenofovir) are generally used for the long term in suitable cases
- In hepatitis C, treatment with direct-acting antivirals (DAA) is most often given for 8-12 weeks
- Regular blood tests and viral load monitoring are performed throughout treatment
- Side effects and treatment response are evaluated through periodic check-ups
- In cirrhotic patients, liver ultrasound and AFP-based cancer screening are performed every 6 months
Post-procedure
- After hepatitis C treatment, HCV-RNA is measured at week 12 to assess sustained virologic response (SVR12)
- In hepatitis B, viral load, ALT, and HBeAg/anti-HBe follow-up is continued every 3-6 months
- In the presence of advanced fibrosis or cirrhosis, lifelong follow-up is planned
- Hepatitis B screening and vaccination of family members is recommended
- Lifestyle recommendations regarding alcohol, hepatotoxic medications, and obesity are provided
Risks
- Nausea, fatigue, or headache due to antiviral medications
- Risk of flare on early discontinuation of hepatitis B treatment
- Rare drug interactions in hepatitis C treatment (especially with cardiac and cholesterol medications)
- Variable treatment response in patients with advanced liver disease
- Persistent risk of liver cancer in cirrhotic patients even when treatment is successful
FAQ
Can hepatitis C be completely treated?
With direct-acting antivirals (DAAs), sustained virologic response is achieved in the great majority of hepatitis C patients. However, liver follow-up is still required in advanced cirrhosis.
How long are hepatitis B medications used?
In hepatitis B, antiviral therapy is generally long term; some patients may require use for years or even lifelong. The duration is determined by the physician.
Can the hepatitis virus be transmitted to family members?
Hepatitis B can be transmitted through blood, sexual contact, and from mother to baby. Hepatitis C is transmitted mainly through blood. Screening of family members and the hepatitis B vaccine for those who are eligible are recommended.
Can I drink alcohol during treatment?
No. Alcohol can increase liver damage and viral load and reduce treatment success; it is not recommended during or after treatment.
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