Primary Care Providers
It is important that primary care providers have the confidence and skills to diagnose people with viral hepatitis – namely hepatitis C (HCV) and hepatitis B (HBV), together with non-alcoholic fatty liver disease (NAFLD), and either manage them with specialist support as needed, or refer them for specialist care.
In the European Union (EU) and United Kingdom (UK), there are an estimated 3.2 and 4.7 million people living with HCV and HBV infection, respectively1-3
Approximately two-thirds of those with HCV are unaware of their status3
Untreated, chronic HCV and HBV may lead to progressive fibrosis, cirrhosis and hepatocellular carcinoma (HCC)4-6
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.7
Overall mortality is significantly higher in people with NAFLD compared to age-matched controls, owing to cardiovascular disease and liver-related deaths8
How can primary care providers make a difference?
Opportunistically test people with risk factors for HCV, HBV and NAFLD
Confirmed HCV: In the absence of contraindications, antiviral treatment should be considered for all individuals5
Confirmed HBV: Monitor to assess for phase of disease and identify when a person should be considered for treatment9
Confirmed NAFLD: Appropriate control of comorbidities; lifestyle interventions as appropriate8
Hepatic Health provides an overview of important issues to enable primary care providers to feel comfortable in the management of people with HCV, HBV and NAFLD, and to ensure that those most in need of treatment are identified and provided with the opportunity to access it.
Community based management
This page explores indications for treatment, antiviral therapy, clinical considerations and long-term patient management.
Assessment and diagnosis
From information on screening tests to advice on when to refer patients with HCV to liver specialists, this page offers a comprehensive overview of the assessment and diagnosis of HCV.
Burden of HBV
Information on the epidemiology of hepatitis B, transmission, at risk populations and natural history.
Prevention and diagnosis
Identifying and screening patients at risk of HBV in primary care, provides a gateway to both prevention and treatment services.
Treatment and management
Information on HBV management options, lifelong monitoring, possible antiviral therapy and surveillance for hepatocellular carcinoma (HCC).
Identifying people with NAFLD
Practical information on noninvasive testing for primary care physicians, covering liver enzymes, fibrosis indices and the Fibrosis-4 index.
Referral and diagnosis of NASH
This page focuses on referral from primary care for patients with suspected advanced fibrosis due to NASH.
Management of NAFLD and NASH
This page focuses on primary care management of NAFLD and secondary care management of advanced fibrosis due to NASH, with reference to European Association for the Study of the Liver (EASL) guidelines where applicable.
Liver disease toolkits
Discover Hepatic Health toolkits for HCV, HBV and NASH and NAFLD, with resources covering prevention, testing, guidelines and more.
- 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.
- European Centre for Disease Prevention and Control. Hepatitis B and C epidemiology in selected population groups in the EU/EEA. Stockholm: ECDC; 2018.
- 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.
- World Health Organization. Guidelines for the care and treatment of persons diagnosed with chronic hepatitis C virus infection 2018. Available at: https://www.who.int/hepatitis/publications/en/ (accessed October 2018).
- EASL. EASL recommendations on treatment of hepatitis C 2018. J Hepatol 2018;69:461-511.
- Lavanchy D. Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures. J Viral Hepat 2004;11:97–107.
- 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).
- Chalasani N, et al. The diagnosis and management of nonalcoholic fatty liver disease: Practice Guidance from the American Association for the Study of Liver Diseases. Hepatology 2018;67:328-57.
- EASL. Clinical practice guidelines on the management of hepatitis B virus infection 2017. Available at: http://www.easl.eu/research/our-contributions/clinical-practice-guidelines (accessed November 2018).
LID/IHQ/18-12//1048E DATE OF PREPARATION: MARCH 2019