HCV Guideline Update: Treat All Patients With New Drugs

Lara C. Pullen, PhD

October 29, 2015

The American Association for the Study for Liver Diseases and the Infectious Disease Society of America (IDSA) have updated HCVguidelines.org so that it reflects the current understanding that virtually all individuals who are positive for the hepatitis C virus (HCV) should receive the newer HCV treatment. The site emphasizes that new sections have been added and that the recommendations are updated regularly as new information becomes available.

The guidelines begin by explaining that new direct-acting oral agents that can cure HCV infection have been approved in the United States. "We've been accumulating understanding of the value and safety of the medications," David L. Thomas, MD, MPH, spokesperson for IDSA, explained to Medscape Medical News. He described the change in position as an "evolution."

When the newer HCV drugs were first introduced, physicians had to rely entirely on data from clinical trials. The new guidelines reflect the addition of real-world physician experience.

The new guidance explains that the sustained virologic response that is characteristic of a successful HCV treatment would benefit almost everyone who is infected with HCV. Moreover, many of the highest-risk patients have already had the opportunity to receive treatment with the new medications.

The IDSA notes that the cost of the new drugs and regional availability of the appropriate healthcare provider may still translate into a need to prioritize patients for treatment.

Some general practitioners will feel comfortable treating their HCV-positive patients, and others will feel more comfortable referring their patients to a specialist for treatment. "A good relationship between physician and patient is crucial to achieving the best outcomes with direct-acting therapies. The physician needs to make an assessment of a patient's understanding of the treatment goals and provide education on the importance of adherence to the therapy and follow-up care," said IDSA panel cochair Gary Davis, MD, in a press release.

Dr Thomas said that although the guidelines are meant to demystify treatment, the most severely affected patients should probably be referred to a specialist. "For hepatitis C, the patients who are often in need of referral are those with severe liver disease and cirrhosis," he explained.

Unfortunately, it is hard for physicians to predict reimbursement from insurance companies. "Our focus is on the physicians and the patients," explained Dr Thomas, calling the world of insurance companies "challenging" and "vexing."

According to HCVguidelines.org, approximately 3 to 4 million individuals in the United States are chronically infected with HCV, and half of them are unaware of their status.

Dr Thomas and Dr Davis have disclosed no relevant financial relationships.

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