Hepatitis‐Viral

Abstract

Journal of Gastroenterology and HepatologyVolume 32, Issue S2 p. 65-86 Supplement ArticleFree Access Hepatitis-Viral First published: 17 August 2017 https://doi.org/10.1111/jgh.13892Citations: 1AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Remote consultation referral system: An effective way to treat homeless and marginalized patients with chronic hepatitis C in primary care N Andric1, W Cheng2, A Chaney1, A Davies1 and J Wolfe1 1Homeless Healthcare, Perth, Western Australia, Australia; 2Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia Background: Up to 20% of the 300 homeless people and those in unstable or transitional housing in Perth have chronic hepatitis C virus (HCV). This is an elusive population to treat, and even with new, highly effective therapy, eradication is often not a priority area for these people. The remote consultation referral system offers an opportunity for patients to have treatment of HCV, and their other complex health needs met opportunistically, in a low-cost and familiar environment of primary care, while still having specialist direction into their long-term liver needs. Aims: To audit outcomes of a community-based model of care for HCV centered in a general practice service specializing in care for homeless and marginalized people in Perth and to identify the treatment enablers in these patients. Methods: A retrospective analysis of patients with HCV treated in primary care using the remote consultation referral system was conducted. Patients with HCV were identified and worked up in primary care across serviced sites including drop-in centers, residential rehabilitation, and a general practice clinic. Remote consultation referral forms were faxed to the tertiary center, and the referral was endorsed and faxed back to the general practitioner to initiate therapy. The general practice-centered model of care relies on collaboration with community pharmacies, case workers, non-government organizations, and specialist liver clinics. Patients with cirrhosis are treated in collaboration or in the tertiary center. Results: From 1 March to 31 December 2016, a total of 57 remote consultation requests were made. All were faxed back within 10 days with consultant endorsement. Twenty-three patients (40%) referred had previously been referred to a tertiary outpatient center for HCV treatment, two of whom attended an appointment. Fourteen patients (25%) commenced treatment in residential rehabilitation, and 18 (32%) were treated in drop-in clinics not requiring an appointment. Thirty-one patients (54%) were homeless or in transitional accommodation that had changed while taking medication. Twenty-five patients (44%) were still actively injecting drugs. Most patients had genotype 3 (53%), and four (7%) had a 24-week treatment course. A third of patients were actively followed up (face-to-face reminder, letter, note, phone call) if they had not presented for timely review. Treatment results are in Figure 1. Of the 14 patients who lost to follow-up, two are in prison, two have died, and eight were treated with excellent compliance in a rehabilitation facility but were lost after they left the facility. The location of four patients is unknown. Figure 1Open in figure viewerPowerPoint Flowchart of treatment results. Conclusion: A general practice-based model of care provides a feasible and effective method for the treatment of HCV among homeless and marginalized people. This transient population requires additional primary care and community support to manage comorbidities and to aid compliance to achieve optimal sustained virological response. Patients in residential rehabilitation have good compliance but can be difficult to follow until SVR12. It is worthwhile giving all transient patients a chance at cure. Comparison of direct-acting antiviral therapy for hepatitis C between specialist centers and primary care: Efficacy and adherence to response assessment S Bloom1,2,10, J Lubel1,10, A Nicoll1,10, P Gow4,9, A Dev3,8, S Roberts2,8, S Bell6,8, I Kronborg7, V Knight3, S Sood5, D Lewis1,10, W Kemp2,8 and on behalf of Melbourne Liver Group (MLG) 1Department of Gastroenterology and Hepatology, Eastern Health, Melbourne, Victoria, Australia; 2Department of Gastroenterology and Hepatology, Alfred Health, Melbourne, Victoria, Australia; 3Department of Gastroenterology and Hepatology, Monash Health, Melbourne, Victoria, Australia; 4Department of Gastroenterology and Hepatology, Austin Health, Melbourne, Victoria, Australia; 5Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; 6Department of Gastroenterology and Hepatology, St Vincent's Hospital, Melbourne, Victoria, Australia; 7Department of Gastroenterology and Hepatology, Western Health, Melbourne, Victoria, Australia; 8Department of Gastroenterology and Hepatology, Monash University, Melbourne, Victoria, Australia; 9Department of Gastroenterology and Hepatology, University of Melbourne, Melbourne, Victoria, Australia; 10Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia Introduction: With the availability of direct-acting antiviral (DAA) therapy in primary care, Australia is in a unique position to eradicate chronic hepatitis C (CHC). Success of this initiative is dependent on uptake and monitoring of efficacy (sustained virological response at 12 weeks [SVR12]). The treatment of CHC has previously been protocol-based and required significant resources and careful patient selection to optimize adherence. Treatment in primary care will remove many of these barriers; however, the effect on adherence to treatment and follow-up is unknown. We aim to study the adherence to DAA treatment protocols and assess outcomes in primary and tertiary care settings. Methods: Participants with CHC were prospectively recruited between October 2014 and November 2016 from 12 primary care practices and compared with patients prospectively recruited and managed solely at specialist centers. All patients underwent clinical, biochemical, virological, and liver stiffness measurement (LSM) assessment. Individuals initially assessed in primary care with an LSM ≥ 12.5 kPa or dual infection were referred to specialist centers. DAA efficacy and adherence to SVR12 testing were monitored in both the primary and specialist centers. Follow-up was censored on 1 April 2017. Results: Overall, there were 1044 participants with CHC recruited. DAA therapy was commenced in 503: 40.6% in primary care (n = 204) and 59.4% in specialist centers (n = 299). At time of analysis, 337 patients had reached their SVR12 date, but only 75% (n = 253) had completed SVR12 polymerase chain reaction testing. In patients with SVR12 data available, cure rates were equivalent between tertiary center and primary care treatment groups (96.2% vs 97.3%, P = 0.668). Treatment failures were seen in genotype 1a and 3 with equal frequency (1.1% vs 1.3%, P = 1.00). LSM ≥ 12.5 kPA was not associated with treatment failure (5.5% vs 2.9%, P = 0.406). Participants commenced on DAA therapy at tertiary centers had greater adherence with SVR12 testing compared with those treated through primary care centers (86.4% vs 52.9%, P < 0.001). On univariate analysis, predictors of adherence were advanced age, LSM ≥ 12.5 kPa, and treatment within a specialist center. Opiate replacement therapy was negatively correlated with adherence to SVR12 testing. On multivariate modeling, opiate replacement therapy (odds ratio [OR], 0.538; P = 0.044) and specialist care (OR, 4.118; P < 0.001) remained predictive of SVR testing at 12 weeks. Conclusion: Community-based treatment of CHC is an essential component of the CHC elimination strategy. Our data indicate that there is no difference in documented SVR12 rates between primary care and tertiary care with DAA therapy, and overall SVR12 rates are comparable to those seen in the DAA registration trials. However, our data raise concerns regarding post-DAA follow-up, which was absent in 47.1% of community-treated patients. Further education and resources are required to optimize adherence to SVR12 assessments, so DAA failures can be identified for the next generation of DAAs. Discontinuation of nucleoside analogue therapy in e-antigen-negative chronic hepatitis B: A meta-analysis G Burns1, S Vogrin2, A Sutherland1, V Sundararajan2, K Visvanathan1,2 and A Thompson1 1St Vincent's Hospital, Melbourne, Victoria, Australia; 2The University of Melbourne, Melbourne, Victoria, Australia Introduction: Nucleos(t)ide analogue (NA) therapy is the mainstay of treatment in e-antigen (eAg)-negative chronic hepatitis B (CHB). Optimal duration of treatment is unclear, and finite therapy has been identified as an important area of unmet need by expert bodies, avoiding the cost and the risks of resistance and long-term adverse events that can be associated with indefinite treatment. We conducted a meta-analysis of the literature surrounding NA discontinuation. Methods: A literature search was performed to identify studies published since 2002 that included patients with eAg-negative CHB who discontinued NAs. Studies were included if cessation was in keeping with the Asian Pacific Association for the Study of the Liver (APASL) guidelines (NA therapy of more than 2 years, undetectable viral load on three occasions at least 6 months apart), and patients were followed for at least 12 months after cessation. We identified 16 studies with a total of 1333 patients. Results: The cumulative rate of virological relapse was 45.0% (P < 0.001) and 62.0% (P < 0.001) at 6 and 12 months, respectively, after NA discontinuation. The estimate of the between-study standard deviation was 0.123 and 0.202, respectively. The cumulative incidence of 6- and 12-month biochemical relapse, as defined by the individual studies, was 20.5% and 39.6%, respectively. Between-study standard deviation was estimated at 0.139 and 0.197, respectively. Duration of treatment, patient age, and sex were not associated with likelihood of reactivation or biochemical relapse. There was one episode of hepatic decompensation, occurring in a patient with cirrhosis who was lost to follow-up and subsequently recovered after NA recommencement. Conclusion: Cessation of analogue therapy is a safe adjunctive management approach in patients with eAg-negative CHB on NA therapy. Further studies are needed to identify long-term outcomes and predictive markers that could guide this treatment approach. A real-world experience treating hepatitis C patients with direct-acting antivirals J Cao, R Liddle, I Kronborg and N Arachchi Department of Gastroenterology, Western Health, Melbourne, Victoria, Australia Background and Aim: Direct-acting antivirals (DAAs) have expanded the treatment options for patients with chronic hepatitis C virus (HCV) infection. The current recommendation is that all patients with HCV should be treated, including patients who had previously failed or did not tolerate interferon-based therapies. The aim of this study was to look at our real-world experience in treating patients with HCV, many of whom were high risk and without other treatment options. Methods: This is a retrospective audit looking at all patients who were treated with interferon-free DAA treatment through the Hepatitis Clinics at Footscray Hospital from January 2015 to December 2016. Results: A total of 184 patients commenced taking DAA treatment during this time. The median age of the patients was 52 years, with 71.7% being male. Of the 184 patients, 53 (28.8%) had previously been treated with interferon-based therapy and 38.6% had liver cirrhosis. As of 1 May 2017, 23 patients did not have results available for sustained virological response (SVR). Three patients had transferred care externally, 15 patients were lost to follow-up, and five were yet to have blood tests. Outcomes were known for 161 patients (87.5%), who were included in the subsequent analysis. Five patients did not complete therapy, three of whom died due to progressive liver decompensation. One patient stopped treatment after 3 weeks due to concerns about interactions with cardiac medications, and one patient stopped after 1 week due to headaches. Of the 161 patients, 146 (90.7%) achieved SVR. There was a 90.4% SVR rate in patients who had previously failed treatment, compared with 90.8% of those who were treatment-naïve. Patients who were non-cirrhotic had an SVR rate of 97.9% compared with 79.7% in patients with cirrhosis. Genotypes 1 and 3 were the most prevalent, making up 59% and 36% of patients, respectively. Among the patients, 90.5% of those with genotype 1 and 89.7% with genotype 3 achieved SVR, while the remaining genotypes had 100% eradication. Nine of the 10 patients who had detectable viral load after completing treatment were cirrhotic. Three of these patients have proceeded on to another DAA regimen. Conclusion: Overall, the data are comparable to the registration trials, with DAA treatment effectively eradicating hepatitis C for many patients. It is particularly effective for non-cirrhotic patients. In addition, previous treatment experience with interferon therapies did not appear to affect SVR rates with DAAs. Although many cirrhotic patients also achieved SVR, this is still suboptimal and more work is required to improve their outcomes. Need for hepatocellular carcinoma screening during direct-acting antiviral treatment for patients with hepatitis C and cirrhosis J Cao, R Liddle, I Kronborg and N Arachchi Department of Gastroenterology, Western Health, Melbourne, Victoria, Australia Background and Aim: Patients with chronic hepatitis C virus (HCV) infection who develop cirrhosis are at a significantly increased risk of developing hepatocellular carcinoma (HCC), at a rate of 2–8% per year. Direct-acting antivirals (DAAs) now allow patients with significant cirrhosis to undergo treatment with high rates of sustained virological response (SVR). It is expected that the incidence of HCC would reduce with increased SVR. However, there have been mixed data regarding this. Early reports suggested a marked increase in incidence of HCC in patients treated with DAAs, while more recent reports have suggested no increased risk. The aim of this study is to determine the incidence of HCC in our cohort of cirrhotic patients undergoing DAA treatment. Methods: This is a retrospective audit of all cirrhotic patients who were treated with interferon-free DAA treatment for HCV at Western Health, Melbourne, from January 2015 to December 2016. Patients who had active HCC at the commencement of treatment and those having interferon within their treatment regimen were excluded. Results: A total of 68 cirrhotic patients had commenced DAA treatment for genotypes 1 to 4. One patient died during therapy due to progressive decompensation. The median follow-up time was 7.9 months from beginning of therapy. Of the 68 patients, 54 (79.4%) had liver imaging during this period. Five patients (7.4%) in total were found to have HCC. Of these, two had a history of HCC that had been previously treated and, on surveillance, did not have evidence of recurrence before therapy. In patients without previous HCC, three of 49 (6.1%) had a new occurrence of HCC. These three patients were overdue for HCC ultrasound surveillance at the time a lesion was identified. In addition to those with confirmed HCC, there were also two patients with indeterminate lesions having ongoing monitoring with radiological surveillance. Conclusion: There was a high risk of recurrence of HCC; however, we did not find a larger increase in HCC incidence than would be expected in a cirrhotic cohort during and within the early post-treatment period. It is difficult to determine whether the incidence of HCC in cirrhotic patients will reduce with SVR and, if so, when. Regardless, the number of patients who had not had HCC surveillance during and after treatment emphasizes the need to maintain active screening during this period, as per society guidelines, particularly when the focus may be more on DAA education, treatment, and monitoring. Project ECHO: A novel tele-mentoring service to aid hepatitis C treatment in difficult-to-access populations PPY Chan1,2, W Mohsen1, M Whelan1, A Glass1, A Ladera1, M Mouton1, E Yeung1, Q Trinh1, S Arora3, S Davison1,2 and MT Levy1,2 1Liverpool Hospital, Sydney, New South Wales, Australia; 2University of New South Wales, Sydney, New South Wales, Australia; 3University of New Mexico, Albuquerque, New Mexico, USA Introduction: Hepatitis C virus (HCV) is now curable with nationally funded direct-acting antivirals; however, its eradication faces many barriers as HCV commonly occurs in difficult-to-access populations (DTAPs), including those with active drug misuse and psychiatric comorbidities. Project ECHO (PE) is a novel “hub and spoke” tele-mentoring program that originated in New Mexico, USA, and was adopted by Liverpool Hospital in July 2016 to empower local clinicians and target DTAPs. Aim: To examine if the PE model can more effectively identify and treat DTAPs with HCV in comparison to a patient cohort treated in an outpatient liver clinic. Methods: This prospective study was approved by the Sydney South West Area Health Service ethics committee. Weekly PE video conference meetings were conducted with local clinicians, including drug and alcohol physicians, sexual health physicians, private methadone prescribers, and community general practitioners. Deidentified HCV cases were presented to a multidisciplinary team of gastroenterologists, nurses, and allied health staff. Information discussed and collected during PE meetings broadly encompassed relevant clinical and biochemical data for formulating treatment plans, psychosocial, and drug-related elements that were considered potential barriers, and treatment outcomes. PE patients were then retrospectively compared with 99 consecutive new HCV patients seen in Liverpool Hospital Liver Clinic since July 2016. Results: Between July 2016 and April 2017, 99 cases of HCV were presented at the PE meetings by local clinicians in the South Western Sydney Local Health District. Thirteen were referred from a sexual health clinic, 68 from various drug health facilities, four from private methadone prescribers, and 14 from GPs. The PE cohort had a greater proportion of female patients (33.3% vs 25.3%) and were younger (median age, 45 years) compared with the liver clinic cohort (median age, 50 years). There were more Indigenous patients in the PE (n = 15) compared with the liver clinic cohort (n = 5). Ongoing substance misuse was prevalent in 43 of 99 PE patients, of whom 31 were active intravenous drug users and 25 had polysubstance misuse, compared with 17 of 99, 12 and 7, respectively, in the liver clinic. Of the 99 PE patients, 73 used opioid substitution therapy, of whom 38 (52.1%) required daily pickups (an indirect indicator of instability), while only 20 clinic patients used opioid substitution therapy, six of whom (30%) required daily pickups. Of the PE patients, 49 have a background of psychiatric illness, with 41 using psychotropic medications, compared with 44 clinic patients who have psychiatric comorbidities, 29 of whom are pharmacologically treated. Cirrhosis was present similarly in PE (13.1%) and liver clinic (18.1%) cohorts. Most were treatment-naive (95.0% and 90.9%, respectively). Genotypes 1, 2, and 3 proportions were similar between PE (44.4%, 6%, and 47.5%, respectively) and liver clinic (39.3%, 6%, and 37.3%, respectively) patients. Genotype 6 was not seen in PE patients, while it comprised 11.1% of liver clinic patients. As of May 2017, 18 of 18 patients in the PE cohort have completed therapy and achieved sustained virological response (SVR), while 46 patients are awaiting completion of treatment. Thirty-two patients did not initiate therapy (13 due to conflicting priorities and 19 were lost to follow-up), and three had treatment ceased early. In contrast, 34/35 liver clinic patients achieved SVR (one relapsed), 44 patients are awaiting completion, and 20 did not initiate therapy (six due to conflicting priorities, eight lost to follow-up, six awaiting future therapies). Conclusion: PE provides an innovative model that facilitates community treatment of HCV in DTAPs who are cared for by other services and differ markedly from those who would attend liver clinics. Furthermore, the teaching approach of PE teleconferencing sessions effectively empowers referring clinicians to become independent prescribers. [Correction added on 15 July 2020, after first online publication: the surname of the 8th author has been corrected from ‘Q TRAN’ to ‘Q TRINH’.] Direct-acting antiviral therapy failures in hepatitis C treatment: A tertiary hospital's experience D Chee, A Majeed, S Roberts and W Kemp Department of Gastroenterology, Alfred Hospital, Melbourne, Victoria, Australia Background: Recent availability of direct-acting antivirals (DAAs) for chronic hepatitis C (CHC) has resulted in high rates of sustained virological response (SVR). To determine the success of therapy, it is recommended that hepatitis C virus (HCV) polymerase chain reaction (PCR) testing is performed 12 weeks after the end of treatment. Treatment failure with DAA therapy is rare but may be due to poor adherence to therapy or viral resistance. Retreatment should be considered in those who have relapsed. Aims: To analyze the prevalence of CHC DAA treatment failures at the Alfred Hospital, Melbourne, since the Pharmaceutical Benefits Scheme listing of DAAs. Methods: All patients who underwent DAA therapy for CHC initiated by the gastroenterology department with drugs dispensed via the hospital pharmacy over an 8-month period from 1 March 2016 to 1 November 2016 were included. Patient demographics, type of DAA therapy, underlying liver cirrhosis, and previous treatment were documented. Patients without documented HCV PCR testing at least 12 weeks after completion of DAA therapy were excluded from the efficacy analysis. Results: A total of 546 patients treated with DAAs during the study period met the inclusion criteria. The most frequent treatment regimens were ledipasvir and sofosbuvir (n = 325), sofosbuvir and ribavirin (n = 30), and sofosbuvir and daclatasvir (n = 191). Overall, 19 patients (3.5%) had DAA treatment failure. The median age was 57 ± 4.6 years, with 16/19 (84%) being male. Of 19 patients who failed DAA therapy, 15 (79%) had evidence of cirrhosis. Five patients (26%) had genotype 1a, four patients (21%) had genotype 1b, two patients (11%) had genotype 2, and eight patients (42%) had genotype 3. Six patients had previously failed peginterferon and ribavirin-based therapy (five were non-responders and one discontinued due to side effects). There were five treatment failures from ledipasvir–sofosbuvir, three from sofosbuvir–daclatasvir–ribavirin, 10 from sofosbuvir–daclatasvir and one from sofosbuvir–ribavirin. Ten patients were treated for 12 weeks, while nine patients were treated for 24 weeks. Six patients have subsequently undergone retreatment. One patient has successfully achieved SVR with retreatment, while five others are undergoing treatment. Conclusions: Our study that patients with hepatitis C in whom DAA therapy fails, while uncommon at about 3.5%, remain an important minority group to manage, particularly as many have cirrhosis. Further studies are needed to explore the reasons for treatment failure, including results of baseline HCV resistance-associated substitution testing, and development of effective retreatment options for this patient population. Applying the REACH-B model to an Australian chronic hepatitis B cohort underestimates the incidence of hepatocellular carcinoma DI Clayton-Chubb1, A Buckle1, M Ho2, CCY Ting2, SJH Chin2, N Lucarelli2, A Nicoll1,2 and J Lubel1,2 1Department of Gastroenterology, Eastern Health, Melbourne, Victoria, Australia; 2Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia Background: Chronic hepatitis B (CHB) infection is present in over 1% of the Australian population. CHB increases the risk of developing hepatocellular carcinoma (HCC), the second most rapidly increasing cancer worldwide. Most international HCC guidelines are based on Asian CHB cohorts, such as the REVEAL study. Subsequent predictive models such as REACH-B have been developed, but their applicability to the multicultural Australian population has never been assessed. Aim: To compare incidence rates and risk factors for developing HCC in an Australian CHB cohort with the REACH-B model. Methods: Patients attending the liver service of a large Australian health service for management of CHB between November 2011 and November 2016 were included. Patient data were collected retrospectively using electronic medical records, and pathology and CHB databases. Basic demographic data, together with viral kinetics and details of HCC surveillance, were recorded. For the purposes of risk calculation, we used the REACH-B predicted 3-year incidence of HCC. We stratified the patients into the 18 individual REACH-B scores possible and aggregated the total number of patient-years exposed to each score to calculate how many HCCs would be expected to develop in our cohort. Complete data with which to calculate a REACH-B score were available for 738 of our patients, and results were then extrapolated for comparison with actual incidences. Results: A total of 1019 patients (506 female, 49.7%) were included in the study (mean age, 49.1 ± 13.5 years), totalling 3203.9 patient-years (mean, 3.1 years per patient). There were 14 cases of HCC found through routine screening (incidence, 1.4%), with a strong male predominance (11/14, 78.6%). Of the 1019 patients, 749 had cirrhotic status documented (12 with HCC and 737 without). Of the 12 with HCC, 10 had cirrhosis (83.3%); of the 737 without, 94 had cirrhosis (12.75%) (relative risk, 6.5). HCC was associated with lower platelets (121.4 vs 208.6; P = 0.00049) and albumin levels (37.1 vs 40.2; P = 0.00602) but higher bilirubin levels (16.5 vs 10.3; P = 0.01829) and INR (1.2 vs 1.0; P = 0.00948). Alanine aminotransferase (ALT) levels were available for 95.4% of patients. ALT level was below 15 IU/L in 100 patients (10.3%), between 15 IU/L and 45 IU/L in 189 patients (19.4%), and over 45 IU/L in the remaining 683 patients (70.3%). This proportion of high ALT values exceeded those in the REVEAL cohorts. Using REACH-B, the predicted incidence of HCC was 6.5 patients. Extrapolating this to our total cohort of 1019, the model predicted that 8.9 patients would have developed HCC in the total 3203.9 patient years—a much lower number than our true incidence of 14. At entry to the study, 288 patients were receiving hepatitis B treatment, including four who developed HCC. Excluding these patients from the analysis led to a REACH-B estimate of 4.7 patients developing HCC from the untreated 731—still much lower than the 10 who developed HCC in our untreated subgroup. Stratifying by sex, the incidence of HCC in the male subgroup markedly exceeded that predicted by REACH-B—11/513 (2.1%) compared with the 6.5/513 (1.3%) anticipated. Conclusion: Surprisingly, the predicted incidence of HCC using the REACH-B model substantially underestimated the rate of development of HCC in our Australian CHB cohort. Possible explanations include selection bias (greater number of cirrhotic patients), elevated ALT levels, and the inclusion of older patients in our cohort compared with the REACH-B cohort. General practitioners' perspectives on and use of remote consultation referral system for hepatitis C treatment in primary care: Interim results A Doyle1, N Kontorinis1, J Kong1, S Nazareth1, M Sebastian1 and W Cheng1,2 1Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia; 2School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia Background and Aim: The introduction of direct-acting antivirals (DAAs) with low toxicity and shorter duration of treatment has revolutionized the management of chronic hepatitis C virus (HCV). The change in Pharmaceutical Benefits Scheme S85 criteria in November 2016 enables general practitioners to treat patients without involving specialists. A remote consultation referral system was developed to support prescription of DAAs in primary care and instituted at Royal Perth Hospital (RPH) in April 2016. We aimed to assess GP perceptions of the remote consultation precept and independent prescribing. Method: GPs who refer patients to the RPH Liver Service were invited to participate in a survey either online or through written questionnaires. Questions included years in practice, caseload, experience, use of the remote consultation referral service, numbers treated to be confident to treat independently, types of patients to be referred, and mode of HCV education. Results: To date, 41 GPs have responded; 22 (54%) of these have been in practice for more than 20 years and six (15%) for less than 5 years. Twenty-four (59%) have seen ≤ 5 patients with HCV in the past year, although five (12%) have seen more than 20. Eleven respondents (27%) have treated at least one patient with the support of our remote consultation service. Of these GPs, 10