Table 1:

Suggested work-up before beginning HCV therapy

Category	Investigation	Considerations
Routine bloodwork	Complete blood count Liver enzymes (alanine transaminase, aspartate transaminase, alkaline phosphatase) Liver function (bilirubin, INR, albumin) Creatinine	Low platelets and elevated bilirubin or INR are suggestive of cirrhosis Renal function is important to determine safety of some regimens
Serology to exclude other infections	HIV Hepatitis B (HBsAg, anti-HBs, anti-HBc)	If HIV-positive, treatment for HIV must take drug interactions into consideration If HBsAg-positive or anti-HBc-positive, see section on HBV coinfection (risk of HBV reactivation) (Appendix 1)
Serology to exclude other common liver diseases	Transferrin saturation (hemochromatosis) IgG	Elevated immunoglobulin G may reflect cirrhosis or possibly autoimmune hepatitis
Staging of liver disease	APRI* FibroTest (serum panel)† Ultrasound* Transient elastography†	All persons with HCV must have evaluation of fibrosis to exclude cirrhosis. Normal ultrasound does not exclude cirrhosis.21 APRI < 0.7 has a very high negative predictive value to exclude cirrhosis22
HCV-specific	HCV genotype and HCV RNA Resistance testing (may be useful in select circumstances)	To select appropriate regimen, and consideration for addition of ribavirin.

Note: anti-HBc = hepatitis B core antibody, anti-HBs = hepatitis B surface antibody, APRI = Aspartate Aminotransferase to Patelet Ratio Index, HBsAg = hepatitis B virus surface antigen, HBV = hepatitis B virus, HCV = hepatitis C virus, HIV = human immunodeficiency virus, IgG = immunoglobulin G, INR = international normalized ratio.

^*All persons with HCV should have a baseline ultrasound and evaluation of fibrosis.

^†Where available, use noninvasive technologies (e.g., transient elastography [FIbroscan], shear-wave elastography, MR-Elastography, or FibroTest).