In an individual who is HCV antibody-positive, current HCV infection should be confirmed by a PCR assay for HCV RNA. Quantitative PCR may be considered as part of the pre-treatment assessment. As noted, the first point-of-care test for HCV RNA was approved by the TGA in May 2020. The Xpert® HCV viral load assay (Cepheid) measures HCV RNA from a finger-prick blood sample (100 mL) and provides a real-time result in less than 60 minutes. This assay will promote the development of hepatitis C “test-and-treat” models of care to increase screening and treatment rates.
Documentation of HCV genotype was important in the era of genotype-specific DAAs. However, the introduction of pan-genotypic treatment regimens for HCV infection means that it is no longer mandatory to determine HCV genotype before prescribing treatment. HCV genotype is not required by the PBS criteria before prescribing sofosbuvir plus velpatasvir (first-line, treatment-naive); glecaprevir plus pibrentasvir (first-line, treatment-naive); and sofosbuvir plus velpatasvir plus voxilaprevir (NS5A inhibitor-experienced).
Documenting HCV genotype may be useful for people at high risk of reinfection, where genotype switch can differentiate reinfection from relapse. HCV genotyping continues to be MBS-reimbursed.
It is important to document any prior treatment for HCV infection. Key information includes treatment regimen, duration, adherence and response. These may influence the choice of treatment regimen and/or treatment duration (see Treatment for chronic hepatitis C). Patients in whom a previous IFN-free regimen has failed frequently have resistant HCV variants.