Hepatitis C for health professionals

District health boards mange hepatitis C patient services. People living with hepatitis C can still contact foundation staff for support.

Prescribing Maviret

  • Maviret is a new medication for the treatment of hepatitis C. It is a combination of two anti-viral medications Glecaprevir and Pibrentasvir, and is active against the six major strains (genotypes) of the virus. The cure rate is expected to be >95 percent.
  • It can be prescribed by any GP, specialist or nurse practitioner.
  • It does not require a special authority or any special paperwork.

Hepatitis C treatment with Maviret – brief advice for prescribers

Pre-treatment work-up:

  • Bloods
    • AST- this is used to calculate APRI score (AST to Platelet Ratio) to assess fibrosis. The AST may not be included in the standard LFT panel in all regions, so it may need to be specifically requested. https://www.hepatitisc.uw.edu/page/clinical-calculators/apri  (upper limit of the reference range is 40)
      • APRI score <1.0: the chance of having liver cirrhosis is very low and no further tests are needed prior to commencing treatment
      • APRI score >1.0: patient may have liver cirrhosis and they should have a Fibroscan to further assess their liver prior to treatment.
  • Fibroscan
    • This assesses liver scarring/fibrosis. If this is present, patient will need hepatocellular carcinoma ultrasound surveillance after hepatitis C cure. If not, then no follow-up scans needed.
    • Referral for Fibroscan varies by region, see below for more information.

Maviret interactions

  • Maviret interacts with a small number of medications (including some statins and oral contraceptive pills). Check for interactions on  hep-druginteractions.org .
  • There is no interaction with cannabis, methadone or buprenorphine (suboxone).
  • Maviret is not recommended for use in liver failure (Child-Pugh B or C cirrhosis).

 Pharmacy:

  • Not all pharmacies can dispense this medication. Go to https://maviret.co.nz/  to find a pharmacy that can dispense Maviret.
  • Maviret may not be held in stock. In this case the pharmacy will call the patient back when it is ready for pick up (usually within a few days).

 Treatment:

  • Dose is three tablets, taken all together once a day, with food, for 8, 12 or 16 weeks.
  • Duration depends on treatment experience, genotype and cirrhosis.
  • For naïve, non-cirrhotic patients treatment is only eight weeks.
  • See below for more information regarding treatment duration.
  • No on-treatment blood test monitoring required.
  • 12 weeks after treatment is finished do an HCV RNA blood test to check your patient has been cured.
  • Cure does not give immunity, encourage harm reduction strategies for those at risk of re-infection.

For further information:

  • See the Medsafe datasheet
  • Liaise with your nearest gastroenterology or infectious diseases specialist
  • Visit www.maviret.co.nz. Healthcare professionals can access further information and resources with the username and password GT1-6. Copies of patient and healthcare specific booklets can be ordered, as well as resources such as “Test me, treat me” posters.

For further background reading about hepatitis C please also see the recently updated BPAC hepatitis C guidelines.

Treatment duration from the Medsafe datasheet

NS5A inhibitors include Ledipasvir (part of Harvoni) and Daclatasvir (not funded in New Zealand but patients may have accessed it via the FixHepC website).

Access to Fibroscan by region

  • For referrals in Auckland and Northland:
    • Order Fibroscans via eReferrals under gastroenterology
    • For gastroenterology assessment and referrals into secondary care services see the Auckland Regional Health Pathway site for chronic hepatitis C”. Northern Regional Alliance is the hepatitis C programme co-ordinator.
  • For referrals in Midlands region (Waikato, BOP, Tairawhiti, Lakes and Taranaki DHBs):  BPAC e-referral – ‘hepatitis C service – community service’ for Fibroscan and patient education. View the pathway of care via the Map of Medicine. Waikato DHB co-ordinate the programme.  Contact Nancy, Hepatitis C and Fibroscan nurse, via 07 839 8899 ext 23017.
  • For referrals in Hawke’s Bay, Palmerston North and Whanganui: use the Map of Medicine referral pathway (Compass Health is the hepatitis C programme co-ordinator). Fibroscan enquiries to programme co-ordinator Gloria on 04 801 7808 or 027 567 6142.
  • Referrals in Wellington, Hutt Valley and Wairarapa: use the 3D Health Pathways (Compass Health is the hepatitis C programme co-ordinator).  Fibroscan enquiries to programme co-ordinator Gloria on 04 801 7808 or 027 567 6142.
  • For the South Island please refer to the local DHB using South Island Health Pathways. South Island Alliance is the hepatitis C programme co-ordinator.

Education and training

Below are links to useful education tools.

Graph showing the most high-risk countries

30 countries account for 80 percent of the hepatitis C cases worldwide.

 

 




© The Hepatitis Foundation of New Zealand 2016