Madison Clinic

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:
History of Present Illness: Dx Date: seroconversion (prior neg HCV test?)? Risk Factors: Transfusion, MSM, tattoos, cocaine snorting, IVDU (with dates of exposure) Symptoms: (ie jaundice, abdominal pain, ascites, hematemesis, encephalopathy) Past w/u of Hep C: genotype, imaging, biopsy Hep C treatment hx: characterize prior response (partial, null or relapse) & toxicities

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

Allergies:

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

Imaging

Pathology

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

Resources

Treating Hepatitis C Co-Infection with Telaprevir

Treating Hepatitis C Co-Infection with Boceprevir

Hepatitis C Co-Infection Side Effect Management

Telaprevir and fat intake Patient handout

 

References

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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