New HCV Guidance: Rapid Updates for Clinicians

Laura A. Stokowski, RN, MS, Helen W. Boucher, MD; Paul Martin, MD

Disclosures

March 21, 2014

In This Article

HCV Science Catching Up to Medical Need

In just 2 or 3 years, the pace of progress in the treatment of hepatitis C virus (HCV) infection has been fairly dramatic. A swift and steady stream of new drugs has challenged clinicians to keep up with the latest recommendations for therapy, and the pipeline is far from dry. The next wave of direct-acting antivirals will continue to target the HCV life cycle from different angles, and combining molecules with different mechanisms of action, different resistance profile, and high antiviral activity will be the name of the game.[1]

Safer, shorter, and more durable treatments are anxiously awaited by many patients already infected with HCV, who have been forestalling treatment or retreatment while waiting for all-oral, interferon-free regimens that will cure their infections without the adverse effects associated with previous drugs. For the rest of the estimated 2-3 million individuals infected with HCV in the United States, all the new drugs in the world are of scant worth if these infections remain undiagnosed.

The recommendation to add a 1-time HCV birth cohort screening for "baby boomers" to exposure risk-based screening[2] is expected to identify more than 800,000 new cases of chronic HCV infection in the United States.[3] Many clinicians -- from those on the frontlines of primary care to the specialists who are experienced in managing HCV and its complications -- will be needed to cope with the burgeoning newly diagnosed population.

The rapid advances in the field of HCV prompted the Infectious Diseases Society of America (IDSA) and the American Association for the Study of Liver Diseases (AASLD), in collaboration with the International Antiviral Society-USA (IAS-USA), to sponsor an effort to synthesize the current evidence in the field, from which was derived a set of expert-developed recommendations for the management of HCV infection, a feat that was accomplished remarkably quickly. The first phase of the HCV guidance, available online at HCVguidelines.org, details the methodology used to develop the guidance, and covers the following sections related to diagnosis, referral, and management:

  • HCV Testing and Linkage to Care;

  • Initial Treatment of HCV Infection in Patients Starting Treatment;

  • Retreatment of Persons in Whom Prior Therapy Has Failed; and

  • Unique Patient Populations (HIV/HCV coinfection, cirrhosis, transplantation, renal impairment).

Sections ("coming soon") that are now being developed for updates of the guidance include:

  • In Whom and When to Initiate Treatment;

  • Monitoring Patients Who Are On or Have Completed Therapy; and

  • Management of Acute HCV Infection.

Clinicians will appreciate the color-coded treatment guidance within the report, allowing them to distinguish at a glance "recommended" (outlined in green) from the "not recommended" (outlined in red) treatment regimens. Each section of the report ends with a quick reference summary of recommendations, and useful resources are provided at exactly the point they might be needed. For example, the section on testing includes a table of commercially available, US Food and Drug Administration-approved anti-HCV screening assays, and a simple algorithm of the recommended sequence for screening, testing, and linking patients to care for ongoing evaluation and management.

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