1. Treating Hep C with Novel Agents

2. Hepatitis C Background
Hepatitis C is a viral infection spread mostly through blood to blood contact that affects the liver and can progress to cirrhosis and liver cancer.
The infection may be asymptomatic for decades, leaving many unaware they are infected.
20% of patients will clear a hepatitis C infection on their own with no medical intervention.

3. Hepatitis C Incidence: 1.0 per 100,000 Prevalence: 3.5 million
Who’s at risk?
Injection drug users, including those who may have used drugs once many years ago.
Infants born to HCV-infected mothers.
People who had blood transfusions, blood products, or organ donations before June,
Health care workers who suffer needle-stick accidents.
How to screen
Use an HCV antibody test to screen for past exposure and current infection.
If ab+ follow up with HCV RNA test to confirm an active infection.

4. Common Novel Medications: (DAAs)
Insurance Coverage: Mavyret is covered under Gold Coast Health Plan. Please check with the other payors for individual plan coverage.
These are very effective oral medications that have significantly less side effects when compared to older interferon based treatments.
Common Novel Medications: (DAAs)

5. Hep C Initial Visit
First, order a Viral load if antibody positive. If Viral load present then proceed with labs and workup below.
All of this information and more can be found at
Order the following labs (within 12 weeks of initiating treatment):
Fibrotest Order via Quest Flexitest
Name: FibroTest-ActiTest Panel
CBC
Test code: 92688
Coags
3.5 mL FROZEN
CMP
AFP
HIV (within 30 days)
Hep C Genotype
Hep A/B antibody (within 30 days) or start Hepatitis Vaccination
Within the last 6 months:
Abd U/S or CT

6. Risk Assessment Tool (RAT)
This tool will help you determine if you should treat the patient or refer them to GI.

7. Hep C Treatment Visit
Use DOT phrase at
There are 2 treatment regimens.
Fibrosis score of 0-3 (non-cirrhotic): Mavyret x 8 Weeks.
Fibrosis score of 4 w/ compensated cirrhosis (Child Pugh A): Mavyret x 12 weeks.

8. Labs and Follow up 8 Week Regimen 12 Week Regimen
At week 4 of treatment: CBC, CMP, Viral Load, Coags
At week 5 of treatment: PCP Visit
At week 6 of treatment: Viral load only if no response at week 4
At week 8 of treatment: AST/ALT
At week 9 of treatment: PCP Visit
At week 20 of treatment: Viral load
At week 21: PCP Visit
At week 4 of treatment: CBC, CMP, Viral Load, Coags
At week 5 of treatment: PCP Visit
At week 6 of treatment: Viral load only if no response at week 4
At week 8 of treatment: AST/ALT
At week 9 of treatment: PCP Visit
At week 12 of treatment: Viral load
At week 13: PCP Visit
At week 24: Viral load
At week 25: PCP Visit

9. Follow Up and Surveillance
At 20 or 24 weeks (dependent on treatment regimen) post completion of therapy, order a viral load test to verify the patient has achieved a sustained virologic response (SVR).
If viral load is undetectable, congratulations your patient is cleared of their hepatitis C infection.

10. Sample Patient 46 YOM with history of IVDU with GCHCP
Viral Load: 816,000 IU/L
HIV: Negative
Hep B: Negative
Previous Treatment: Yes, Interferon only
Immune Modulating Medications: None
Fibrosis Score: 2
Cirrhosis: Yes, compensated
Child Pugh: A

11. RISK ASSESSMENT TOOL

12. Treatment Compensated Cirrhotic 12 weeks of Mavyret
Rx sent to Caremark CVS utilizing a care manager
Follow labs as outlined above
Cured at 24 weeks with a SVR

13. Resources Everything you need to start can be found here:
Tipu V. Khan, MD, FAAFP
Principal Investigator
Faculty, Family Medicine Residency Program, Ventura County Medical Center
Phone: (805)
Pager: (805)
or TigerText
Dr. Scott Underwood
Medical Director, Specialty Care Services