Recent estimates suggest that:

Liver disease contributes to more than 150,000 deaths annually1

Around 3.2 million people are affected by hepatitis C virus (HCV) infection and a further 4.7 million are living with chronic hepatitis B virus (HBV)2-4

The prevalence of non-alcoholic fatty liver disease (NAFLD) in the general population is 20-30%, being more common in people who have type 2 diabetes or metabolic syndrome.5

The relative scarcity of specialist services, compared with the prevalence of these diseases, clearly suggests that treatment cannot be managed by specialists alone. Fortunately, the availability of highly effective and well-tolerated oral therapies for HCV and HBV, now provides an opportunity for the involvement of non-specialists in prescribing.6  Moving forward, an integrated approach between specialists, primary care providers, drug and alcohol services, nurses and allied health staff will be essential for managing the burden of disease and providing better outcomes for people with chronic liver diseases.

Liver specialists (i.e. gastroenterologists, hepatologists, infectious disease clinicians) maintain a fundamental role in the implementation of this new treatment paradigm, including:

Provision of education, training and facilitating treatment by non-specialists in non-hospital settings

Advice and assistance to prescribers who are new to treating HCV, HBV and/or NAFLD

As consultants for people with treatment-refractory disease, complex comorbidities and advanced liver disease

Community based management of HCV

HCV

This page explores indications for treatment, antiviral therapy, on-treatment monitoring and long term patient management. 

Screening tests for HCV

HCV

This content focuses on screening tests for possible HCV infection and interpretation of results. 

Pre-treatment assessment of patients with chronic HCV

HCV

Pre-treatment assessments covering: HCV genotype, clinical history, physical examination and evaluation for cirrhosis. 

HBV treatment and management

HBV

Information on treatment and monitoring, surveillance for hepatocellular carcinoma (HCC) and education, support and lifestyle advice. 

Elimination projects

HCV

Information on ongoing HCV elimination projects, results to date and models of care. 

Liver disease toolkits

HCV

A collection of HCV, HBV and NASH and NAFLD resources, including information on prevention, diagnosis, guidelines and screening tools.

Referral and diagnosis of NASH

Exploring diagnostic testing and outcomes for patients with suspected nonalcoholic steatohepatitis (NASH). 

Management of NAFLD and NASH

Information on lifestyle interventions, surgical interventions and multidisciplinary management of patients with NAFLD and NASH.

References

  1. Pimpin L, et al. Burden of liver disease in Europe: Epidemiology and analysis of risk factors to identify prevention policies. J Hepatol 2018;69:718-35.
  2. Hofstraat SHI, et al. Current prevalence of chronic hepatitis B and C virus infection in the general population, blood donors and pregnant women in the EU/EEA: a systematic review. Epidemiol Infect 2017;11:1-13.
  3. European Centre for Disease Prevention and Control. Hepatitis B and C epidemiology in selected population groups in the EU/EEA. Stockholm: ECDC; 2018.
  4. European Union HCV Collaborators. Hepatitis C virus prevalence and level of intervention required to achieve the WHO targets for elimination in the European Union by 2030: a modelling study. Lancet Gastroenterol Hepatol 2017;2:325–336.
  5. National Institute for Health and Care Excellence. Non-alcoholic fatty liver disease (NAFLD): assessment and management. July 2016; available at: http://nice.org.uk/guidance/ng49 (accessed December 2018).
  6. Hepatitis C Virus Infection Consensus Statement Working Group. Australian recommendations for the management of hepatitis C virus infection: a consensus statement (September 2018). Melbourne: Gastroenterological Society of Australia, 2018.

LID/IHQ/18-12//1048E DATE OF PREPARATION: MARCH 2019