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Viral Hepatitis

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Management and Treatment of Hepatitis C Viral Infection: Table 2

for Health Care Providers

Table 2. Pretreatment Assessments in Patients with Chronic HCV Infection

NECESSARY

  • Medical history, including complications of liver disease, presence of significant extrahepatic disease, and symptoms of chronic HCV that may diminish quality of life
  • Psychiatric history, including past or ongoing psychiatric and substance use disorders
  • Screening for depression and alcohol use
  • Biochemical markers of liver injury and assessment of hepatic function, including ALT, albumin, bilirubin (particularly direct bilirubin), and prothrombin time
  • White blood cell counts with differential, hemoglobin, hematocrit, and platelets
  • Thyroid function tests
  • Serum creatinine
  • Serum glucose or glycosylated hemoglobin (HbA1c) in diabetics
  • Pregnancy test (in women of childbearing age)
  • HIV serology
  • Serum HBsAg, anti-HBc, anti-HBs, anti-HAV (total)
  • Quantitative HCV RNA measurement
  • HCV genotype
  • Previous antiviral therapies and response
  • Electrocardiogram in preexisting cardiac disease

HIGHLY RECOMMENDED

  • Liver biopsy to stage severity of liver disease (especially in HCV genotype 1 infection)
  • Eye exam for retinopathy in patients with diabetes or hypertension
  • Serum ferritin, iron saturation and serum ANA
  • Urine toxicology screen for opiates, cocaine, and amphetamines
ALT = alanine aminotransferase; HBsAg = hepatitis B surface antigen; anti-HBc = antibodies to hepatitis B core antigens; anti-HBs = antibodies to hepatitis B surface antigens; anti-HAV = antibodies to hepatitis A virus; ANA = antinuclear antibodies.