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  1. Further evaluate patients with signs or symptoms of liver disease or abnormal liver test results, regardless of duration, with a goal of determining the etiology.

  2. Perform one-time, routine, opt-out screening for hepatitis C virus (HCV) in all individuals 18 years or older.

  3. For patients at risk of reinfection with HCV (ie, patients previously treated or with a spontaneously resolved past infection), test for HCV infection with an RNA polymerase chain reaction test (not an HCV antibody test).

  4. For patients with nonalcoholic steatohepatitis (NASH), recommend weight loss of 10% or greater for NASH management.

  5. Refer patients with cirrhosis and a Model for End-stage Liver Disease (MELD) score of 15 or greater, complications of cirrhosis (ie, ascites, hepatic encephalopathy, variceal bleeding), or hepatocellular carcinoma for evaluation for liver transplantation.

Resources

  1. Strength of Evidence: SORT C

    Source: Am Fam Physician, reference 13

  2. Website: https://www.aafp.org/afp/2019/1215/p759.html

  3. Strength of Evidence: SORT A

    Source: American Association for the Study of Liver Diseases/Infectious Diseases Society of America, reference 27

  4. Website: https://aasldpubs.onlinelibrary.wiley.com/doi/10.1002/hep.31060

  5. Strength of Evidence: SORT A

    Source: American Association for the Study of Liver Diseases/Infectious Diseases Society of America, reference 27

  6. Website: https://aasldpubs.onlinelibrary.wiley.com/doi/10.1002/hep.31060

  7. Strength of Evidence: SORT C

    Source: American Association for the Study of Liver Diseases, reference 10

  8. Website: https://aasldpubs.onlinelibrary.wiley.com/doi/10.1002/hep.29367

  9. Strength of Evidence: SORT B

    Sources: Am Fam Physician, American Association for the Study of Liver Diseases/American Society of Transplantation, references 13 and 109

  10. Websites: https://www.aafp.org/afp/2019/1215/p759.html; https://aasldpubs.onlinelibrary.wiley.com/doi/10.1002/hep.26972

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