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Hepatitis C Co-infection Clinic
Who: Shireesha Dhanireddy, MD Bob Harrington, MD Nina Kim, MD Ji Lee, PharmD Bob Loeffelbein, PharmD
What: The Madison Hepatitis C Co-Infection Clinic is available to any co-infected patients who is interested in management of hepatitis C, which includes optimizing pre-treatment issues, discussion of treatment, toxicities and drug interactions, and referral to treatment studies. The clinic will operate as a referral service and work closely with primary providers to enhance care of hepatitis C-infected individuals.
When: The clinic meets every other Friday morning (as well as some Tuesday mornings), however, pharmacy providers are available outside of clinic times. Where: Madison Clinic
How: The initial referral should be placed through the patient care coordinator.
Any questions about the clinic, please contact Shireesha Dhanireddy, Bob Harrington, or Nina Kim.
Hepatitis C Co-Infection Clinic Initial Visit
Patient Identification/Chief Complaint:
HIV disease status:
Mental health history: Consider PHQ-9 ROS:
Past Medical History: Ask about autoimmune diseases, thyroid disease, diabetes, cardiopulmonary disease, cytopenias, gout, hep B coinfection, seizure disorder (if peginterferon use anticipated)
Social History: EtOH use: if still drinking, quantify use Illicit drug use MJ use Tobacco use Housing status Sexual partners
Medications: ART Regimen: OTC meds/supplements:
Any immunosuppessive therapy
Family History: Liver disease? Autoimmunity?
Physical Examination: Note any stigmata of chronic liver disease
Pertinent Laboratory Studies: CD4 count; HIV RNA Hep C genotype, HCV RNA quant WBC; HCT; PLT ; AST; ALT; Bili, creatinine; PT/INR if cirrhotic
Hep A and B immune status
FibroSure – Consider obtaining on patients averse to or who have contraindications for liver biopsy. Not as accurate for mid-stages of disease and difficult to interpret in patients with hyperbilirubinemia (ie on atazanavir) or acute liver inflammation as these conditions can falsely elevate values
Impression / Recommendations: Address potential barriers – ie mental health issues, alcohol/illicit drug use, drug interactions Discuss potential complications if cirrhosis present (calculate Child Pugh score) and address screening for HCC and varices Discussion about imaging/biopsy, if warranted Address whether pt interested in treatment study
Hepatitis C therapy: highlights from the 2012 annual meeting of the European Association for the Study of the Liver. Clin Infect Dis. 2013 Feb;56(4):560-6. doi: 10.1093/cid/cis915. Epub 2012 Oct 22.
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