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id.hcv-initial.chronic.v1

Hepatitis C — initial evaluation & DAA

infectious_diseasechronicadultoutpatienttransition
Start encounter →Print handoutPRODUCTION

Manifest is a Batch-23 scaffold — atoms / phenotypes / regimen drug list not yet authored. PMIDs empty until WebSearch verifies AASLD/IDSA + EASL 2025 web-published guidance citations (web-only updates lack stable PMIDs). Regimen axis intentionally empty — Epclusa / Mavyret + treatment-experienced regimens require manifest backing. Decompensated cirrhosis + treatment-experienced phenotypes route to a separate dossier when authored.

Entry points (4)

  • lab_abnormality
    HCV antibody positive (IDSA 2024)
    hcv_ab_positive
  • lab_abnormality
    HCV RNA detectable on screening (IDSA 2024)
    hcv_rna_detectable
  • lab_abnormality
    Unexplained ALT elevation in at-risk individual (IDSA 2024)
    elevated_alt_unexplained
  • problem_list
    Known HCV not yet treated (IDSA 2024)
    hcv_existing_diagnosis

Required inputs (11)

  • hcv_rnarequired
    lab • used at INITIAL_WORKUP
    Confirms active infection vs cleared exposure (IDSA 2024)
  • hcv_genotype
    lab • used at DIFFERENTIAL
    Pan-genotypic DAAs apply but genotype 3 affects regimen + duration in cirrhotics (IDSA 2024)
  • hbv_serologiesrequired
    lab • used at CONTEXT
    HBV co-infection screen — DAA can reactivate HBV; FDA boxed warning (IDSA 2024)
  • hiv_testrequired
    lab • used at CONTEXT
    Co-infection alters regimen choice + drug-drug interactions (IDSA 2024)
  • lftrequired
    lab • used at INITIAL_WORKUP
    Baseline ALT/AST + bilirubin; drives Child-Pugh staging if cirrhotic (IDSA 2024)
  • plateletsrequired
    lab • used at INITIAL_WORKUP
    FIB-4 + APRI inputs; portal HTN marker (IDSA 2024)
  • creatininerequired
    lab • used at TREATMENT
    eGFR for sofosbuvir-based regimen choice (now safe at all eGFR) (IDSA 2024)
  • prior_daa_treatmentrequired
    history • used at CONTEXT
    Treatment-experienced affects regimen + duration (IDSA 2024)
  • cirrhosis_statusrequired
    history • used at CONTEXT
    Compensated vs decompensated drives regimen + HCC surveillance (IDSA 2024)
  • current_medsrequired
    medication • used at TREATMENT
    DAA drug-drug interactions (PPI with velpatasvir, statins, amiodarone) (IDSA 2024)
  • fibroscan_or_us
    imaging • used at INITIAL_WORKUP
    Stage liver fibrosis (F0-F4); HCC screening if cirrhotic (IDSA 2024)

12-phase flow (11)

  1. 1FRAME
    Chronic HCV initial evaluation; acute HCV / treatment-experienced / decompensated cirrhosis covered by sibling engines (IDSA 2024)
    advance: scope confirmed (chronic, treatment-naive, compensated by default)
  2. 2ENTRY
    Confirmatory HCV RNA after positive antibody (IDSA 2024)
    inputs: hcv_rna
    advance: active infection confirmed
  3. 3CONTEXT
    HBV / HIV co-infection, prior DAA exposure, cirrhosis status, comorbid CKD, current meds for DDI (IDSA 2024)
    inputs: hbv_serologies, hiv_test, prior_daa_treatment, cirrhosis_status, current_meds
    advance: risk + co-infection profile complete
  4. 4INITIAL_WORKUP
    CBC, CMP, INR, FIB-4 / APRI, FibroScan or US, HCC AFP if cirrhotic, vaccination check (HAV, HBV) (IDSA 2024)
    inputs: lft, platelets, creatinine
    actions: panel.lft, panel.cbc, panel.renal
    advance: fibrosis stage assigned
  5. 5BRANCHING_WORKUP
    Genotype only if needed for treatment-experienced or decompensated; HCC surveillance US q6mo if cirrhotic (IDSA 2024)
    inputs: hcv_genotype
    advance: genotype obtained when relevant
  6. 6DIFFERENTIAL
    Confirm HCV as primary driver vs alcohol / MASLD / other viral; cryoglobulinemia / vasculitis / GN extrahepatic flags (IDSA 2024)
    inputs: lft
    advance: driver hierarchy clarified
  7. 7RISK_STRATIFICATION
    Compensated F0-F3 vs F4 compensated vs decompensated; CKD; prior DAA failure (IDSA 2024)
    advance: treatment tier assigned
  8. 8TREATMENT
    Pan-genotypic DAA — sofosbuvir/velpatasvir (Epclusa) 12 wk OR glecaprevir/pibrentasvir (Mavyret) 8 wk for treatment-naive non-cirrhotic / compensated cirrhotic; avoid protease-inhibitor regimens in decompensated cirrhosis; manage DDIs (PPI, amiodarone, statins, carbamazepine) (IDSA 2024)
    inputs: current_meds, cirrhosis_status
    advance: regimen chosen, DDIs reconciled, treatment started
  9. 9DISPOSITION
    Outpatient unless decompensated → hepatology + transplant evaluation (IDSA 2024)
    advance: level of care set
  10. 10MONITORING
    On-treatment LFT week 4 if abnormal baseline; SVR12 (HCV RNA) 12 weeks after end of therapy (IDSA 2024)
    inputs: lft
    actions: panel.lft
    advance: SVR12 documented (cure)
  11. 11FOLLOWUP
    Cirrhotic → lifelong HCC surveillance US ± AFP q6 months despite cure; reinfection education / harm reduction; hepatology continuity (IDSA 2024)
    advance: long-term plan documented