This document outlines guidelines for screening and treating hepatitis C virus (HCV) in cancer patients. It recommends screening all cancer patients for HCV, HBV, and HIV. For patients who test positive for HCV, it advises further tests to assess liver function and damage. It states that all chronic HCV patients should be treated, except those with a short life expectancy, using direct-acting antiviral regimens like sofosbuvir and daclatasvir for 12 weeks without ribavirin or injections. It recommends monitoring patients during and after treatment to check for sustained virologic response.
2. Screening a cancer patient
Every cancer patient must be screened for HBV, HCV and HIV
Chemotherapy related reactivation of viral illnesses
HBV, HCV and HIV associated lymphomas
3. HCV
Anti HCV by Elisa
False positive
Recovery from past infection
HCV by PCR Qualitative
4. If HCV positive
LFTs including Albumin and INR to assess liver function
USG abdomen for hepatobilliary system to look for stigmata of chronic liver disease if any
Cirrhosis of liver
Increased portal vein diameter
Splenomegaly
Ascites
SOL in case there is cirrhosis
5. Whom to treat
All patients with chronic HCV infection
Except those with a short life expectancy that cannot be remediated by HCV therapy, liver
transplantation, or another directed therapy.
6. Further work up
HCV by PCR Quantitative
HCV Genotype
Upper GI endoscopy to look for varices (if liver cirrhosis on USG abdomen)
7. Treatment
DAAs:
Sofosbuvir 400 mg once a day for 12 weeks
Daclatasvir 60 mg once a day for 12 weeks
No ribavirin
No injections
8. Follow up
HCV by PCR Quantitative at the end of 4 weeks (Interim)
HCV by PCR Quantitative at the end of 12 weeks (EOT)
9. SVR
The continued absence of detectable HCV RNA for at least 12 weeks after completion of therapy.
HCV antibody positive but HCV RNA not detectable in serum, liver tissue, or mononuclear cells,
and achieve substantial improvement in liver histology.
