Hepatitis C virus (HCV)
Patients with HCV infection can be managed within the Hepatology services at the Royal Infirmary of Edinburgh, or the Regional Infectious Diseases Unit at the Western General Hospital. Some treatment clinics are run jointly with Substance Misuse Directorate, Primary Care health centres, and pharmacies.
Treatment of HCV is well tolerated and highly effective; almost 100% of infections are cured by tablets taken once daily for 8-12 weeks. All patients with evidence of active HCV infection should be referred for consideration of antiviral treatment. Where appropriate, patients with cirrhosis will be offered enrolment into HCC surveillance, consisting of 6 monthly liver ultrasound and serum AFP measurement, arranged through the Centre for Liver and Digestive Disorders (CLDD).
Testing:
Hepatitis C antibody testing is performed as the initial screening test (4.9mL brown capped gel tube). If the patient is already known to be HCV antibody positive, please send HCV RNA quantitative PCR to confirm active infection (9mL (or 2 x 2.6mL) red cap EDTA tubes).
The lab will reflexively test HCV PCR on all new HCV antibody positive samples.
For patients with poor venous access or needle phobia, dried blood spot (DBS) testing is also available – contact community BBV team at RIDU on 0131 537 2820 or email communitybbvteam@nhslothian.scot.nhs.uk.
HCV antibody does not confer immunity to subsequent infection; HCV antibody positive and PCR negative patients should be counselled regarding risk factors for re-infection and offered regular screening with HCV PCR if there is ongoing exposure.
Please see the BBV page for additional information on testing, referrals, primary care management and resources.
C.M & E.S/N.B 06-02-24
Who to refer:
All those with evidence of active HCV infection (HCV PCR positive) should be referred for consideration of antiviral treatment.
Who not to refer:
Those who are hepatitis C antibody positive and HCV PCR negative (this indicates past infection). However, consider repeat testing if there has been a potential exposure in the 2 weeks preceding HCV PCR testing, and offer regular testing if the patient is at ongoing risk of BBV acquisition.
Where to refer:
Regional Infectious Diseases Unit (RIDU), WGH, Edinburgh
Wards 41/42/43, Western General Hospital, Edinburgh
Tel. 0131-537 2820/2823 (OPD Reception)
The RIDU team is happy to see patients with evidence of active infection with HBV or HCV, and patients living with HIV. All patients co-infected with more than one blood borne virus should be referred to RIDU.
GP teams should refer via SCI Gateway but referrals by letter are also accepted.
Centre for Liver and Digestive Disorders (CLDD), RIE
Tel. 0131-242 3063
The CLDD provides care, monitoring and treatment for people with viral hepatitis including hepatitis B and C +/- liver disease, and particularly for those with advanced disease.
The on-call consultant and registrar can be contacted for advice, urgent clinic appointments and admissions via RIE switchboard.
GP teams should refer via SCI Gateway for routine referrals.
- Nurse led outreach clinics
These are run by RIDU and CLDD staff, held in various locations across Lothian depending on need and staff availability. Staff will discuss options with patients on a case-by-case basis.
Patients should be offered screening for HIV and HBV infection.
All patients with HCV should be offered or referred for a course of HBV vaccine unless known to be immune/infected (people living with HIV will be offered this at the treatment centre).
All patients with HCV should be given general lifestyle advice, including advice on minimising/stopping alcohol, and weight reduction/healthy eating advice if BMI >25.
Any patient with active HCV infection should be encouraged to attend a treatment clinic. Even if they are not currently wanting treatment they will be seen for monitoring and support.
Patients with chronic hepatitis who do not wish to be referred / do not attend are at risk of complications of cirrhosis / cancer and need to be aware of this. They should be strongly encouraged to accept referral to secondary care and every opportunity taken to prompt this and check LFTs if they present again. Please note that patients with an AST/ALT ratio greater than 1 are at risk of complications of cirrhosis.
If appropriate, patients with cirrhosis should be offered enrolment into HCC surveillance, consisting of 6 monthly liver ultrasound and serum AFP measurement, arranged through the CLDD.
See also page on Primary Care management of BBVs.
Please see the Resources and Links section of the Blood Borne Viruses page
