What are the treatment guidelines for chronic hepatitis C (hep C) infection?

Updated: Oct 07, 2019
  • Author: Vinod K Dhawan, MD, FACP, FRCPC, FIDSA; Chief Editor: BS Anand, MD  more...
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Hepatitis C has become a curable disease with the use of antiviral agents (>95%). [1] Treatment for chronic HCV is based on guidelines from the Infectious Diseases Society of America (IDSA) and the American Associations for the Study of Liver Diseases (AASLD), in collaboration with the International Antiviral Society-USA (IAS-USA). [34, 9] These guidelines are updated often.

The AASLD/ISDA guidelines previously proposed that because all patients cannot receive treatment immediately upon the approval of new agents, priority should be given to those with the most urgent need. The recommendations included the following [34] :

  • Patients with advanced fibrosis, those with compensated cirrhosis, liver transplant recipients, and those with severe extraheptic complications are to be given the highest priority for treatment.

  • Based on available resources, patients at high risk for liver-related complications and severe extrahepatic hepatitis C complications should be given high priority for treatment.

  • Treatment decisions should balance the anticipated reduction in transmission versus the likelihood of reinfection in patients whose risk of HCV transmission is high and in whom HCV treatment may result in a reduction in transmission (eg, men who have high-risk sex with men, active injection drug users, incarcerated persons, and those on hemodialysis).

More recently, the AASLD/ISDA guidelines have removed their prioritization tables but continue to strongly recommend treatment for all patients with chronic HCV infection, barring those with shortened life expectancies that cannot be resolved by HCV treatment, liver transplantation, or another directed therapy. [9]

With the exception of pregnant women, the World Health Organization recommends treatment be offered to all individuals aged 12 years or older diagnosed with HCV, regardless of their disease stage. [50]

Initiating treatment earlier for patients with lower stage fibrosis may extend the benefits of sustained virologic response (SVR). In a long-term follow-up study, 820 patients with METAVIR stage F0 or F1 fibrosis confirmed by biopsy were followed for up to 20 years. The 15-year survival rate was statistically significantly better for those who experienced SVR (93%) compared to those whose treatment had failed (82%) or for those who remained untreated (88%) (P =.003). [76]

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