Hepatitis C for health professionals

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

Fibroscan referrals for patients with chronic hepatitis C

All Fibroscan referrals should be made through your health pathway.

• For referrals in Auckland and Northland please refer to the local DHB using Auckland Region Health Pathways (Northern Regional Alliance is the hepatitis C programme co-ordinator)

• For referrals in the Midlands region, please use BPAC e-referral – ‘hepatitis C service – community service’ for Fibroscan and patient education service and view the pathway of care via the Map of Medicine. Waikato DHB is the hepatitis C programme co-ordinator. If patients have any questions about their Fibroscan appointment they can call Kathryn on (07) 839 8899 ext: 96289.

• For referrals in the Hawke’s Bay, Palmerston North and Whanganui, please use the Map of Medicine referral pathway (Compass Health is the hepatitis C programme co-ordinator). If patients have any questions about their Fibroscan appointment they can call Gloria on 027 567 6142.

• Referrals in Wellington, Hutt Valley and Wairarapa, please use the 3D Health Pathways (Compass Health is the hepatitis C programme co-ordinator). If patients have any questions about their Fibroscan appointment they can call Gloria on 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).

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 higher than 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 Maviret treatment - pre-treatment work-up:

• Bloods

AST – this is used to calculate an 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. The upper limit of the reference range is 40.

APRI score >1.0: patient may have liver cirrhosis and they should have a Fibroscan to further assess their liver prior to treatment.

APRI score <1.0: the chance of having liver cirrhosis is very low and no further tests are needed prior to commencing 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.

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:

• A range of pharmacies around New Zealand 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 eight weeks.

• See below for more information regarding treatment duration.

• No on-treatment blood test monitoring is required.

• Do an HCV RNA blood test 12 weeks after treatment is finished to check your patient has been cured.

• Cure does not give immunity, encourage harm reduction strategies for those at risk of re-infection.

Further information is available on the Medsafe datasheet or on the Maviret website. 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 BPAC hepatitis C guidelines.