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Hepatitis C

Why is hepatitis C so important in general practice? This serious chronic infection is now believed to affect over 200 000 Australians, including patients in your practice.

In 1999, The Royal Australian College of General Practitioners developed a then groundbreaking supplement on the primary care management of hepatitis C virus (HCV) infection – Hepatitis C: A management guide for general practitioners published by Australian Family Physician.

Due to ongoing demand, this issue of AFP presents eight updated chapters from the original guidelines and provides the opportunity to revisit hepatitis C four years on.

In an original editorial¹ in 1998, I stated that hepatitis C had become the new challenge for general practitioners in the 1990s. In 2003, hepatitis C remains an important challenge. While the pattern of the disease is changing, there is no evidence that any of the previously identified challenges have waned and there are now around 20 000 new cases of hepatitis C notified in Australia each year.²

Most GPs are now more familiar with hepatitis C management through ongoing contact with their own patients and many are now well experienced in the counselling issues facing these patients. We are also able to better understand the long term physical and psychological aspects of hepatitis C including chronic liver damage, reproductive issues, depression and anxiety. Our patients affected by hepatitis C continue to be a diverse group, including people from often marginalised groups such as injecting drug users, people from non-English speaking backgrounds, indigenous Australians and recipients of blood products. Hepatitis C remains a chronic, continuing condition well suited for initial diagnosis, management and ongoing monitoring in the general practice setting.

Significant numbers of our patients will develop long term complications of chronic hepatitis C including cirrhosis and hepatocellular carcinoma.³ As GPs, we need to be aware of which patients will benefit most from advances in antiviral therapy and the best time to refer these patients.⁴

Testing with HCV PCR now attracts a Medicare rebate, and through a pilot training program by the Australasian Society for HIV Medicine, some New South Wales GPs are now prescribing interferon and ribavirin. General practitioners in other states may soon follow.

As GPs, we remain the health care workers still most likely to see cases of acute HCV infection. Around 80% of cases of hepatitis C have occurred through injecting drug use, and while the percentage of cases in other groups is smaller, the number of recorded cases in Australia (now over 180 0002) makes this number highly significant. While patient education for the prevention of HCV transmission has always been a large part of GP management of hepatitis C, the increasing numbers of people diagnosed, combined with the shift toward increasing management in the primary care setting, places an even larger public health responsibility upon us.

Australian GPs are responding to the needs of our patients, but we need access to up-to-date resources tailored to our specific clinical needs in the face of a still changing epidemic. It is in this spirit of commitment to quality care that our colleagues have authored the AFP Hepatitis C update for primary care management.

References

1. Kidd M. The challenge of hepatitis management in Australian general practice. Aust Fam Physician 1998; 27(9):769.
2. Dore G J, Kaldor J M, MacDonald M, Law M G. Epidemiology of hepatitis C virus in Australia. Aust Fam Physician 2003; 32(10):796–798.
3. Batey G. Chronic hepatitis C. Aust Fam Physician 2003; 32(10):807–811.
4. Sievert W, Korevaar D. Antiviral therapy for chronic hepatitis. Aust Fam Physician 2003; 32(10):826–832.

Last Modified: 30 October 2003
Authorised By: Australian family Physician