Simplified HCV treatment regimens now recommended in suitable patients
Joint guidelines from the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America now recommend simplified treatment regimens for patients with chronic hepatitis C virus (HCV) infection who are considered eligible.
Direct-acting antiviral regimens successfully cure hepatitis infection in more than 95% of treated patients. The recent development of pangenotypic regimens that require relatively shorter treatment durations has greatly simplified antiviral therapy.
To be eligible for simplified treatment, patients must be adults with chronic hepatitis C infection (any genotype) who do not have decompensated cirrhosis and have not previously received treatment for their condition. Any patient with end-stage renal disease, known or suspected hepatocellular carcinoma, or a history of liver transplant are not eligible for simplified treatment. In addition to this, pregnant women and patients who are HIV or hepatitis B surface antigen (HBsAg) positive are also not eligible.
The recommended simplified regimens are glecaprevir/pibrentasvir for 8 weeks, or sofosbuvir/velpatasvir for 12 weeks.
It is thought that these simplified regimens may expand the number of healthcare professionals who prescribe antiviral therapy, and therefore increase the number of patients who are treated. The regimens are designed to be used by any healthcare provider who is knowledgeable about hepatitis C and its management. This aligns with the National Academies of Science, Engineering, and Medicine's plan to eliminate hepatitis C infection as a US public health burden by 2030.
The simplified treatment algorithms provide clear, concise guidance on pretreatment assessment, on-treatment monitoring, assessment of response, and follow-up.
The guidelines have also been updated to remove less efficacious, complex alternative regimens.
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Transmission is through percutaneous exposure to infected blood, most commonly through injection of illicit drugs or transfusion of contaminated blood products in developed countries, or via contaminated medical or dental equipment in resource-poor countries.
Following acute exposure to hepatitis C virus, many patients develop chronic hepatitis C. Most infections are asymptomatic; however, hepatic inflammation is often present and can lead to progressive hepatic fibrosis.
The goal of treatment is to eradicate the virus, achieve a sustained virologic response, and prevent disease progression. Oral direct-acting antiviral therapies are standard treatment.
Long-term complications of chronic infection include cirrhosis or hepatocellular carcinoma.
Hepatitis C virus (HCV) is an infectious, hepatotropic virus belonging to the Flavivirus family. Infection may present as an acute illness (e.g., fatigue, arthralgia, jaundice) in approximately one third of patients; however, the majority of patients are asymptomatic. Chronic infection causes liver inflammation and fibrosis, and a significant number of these patients will develop cirrhosis and liver failure or liver cancer over a period of approximately 20 to 50 years. The infection rarely resolves spontaneously in patients with chronic infection.
History and exam
- unsafe medical practices
- intravenous or intranasal drug use
- blood transfusion or organ transplant
- heavy alcohol use
- interleukin (IL)-28B gene polymorphism
- healthcare work
- multiple sex partners
- infected mother (for fetus)
- male sex
Professor of Medicine
Division of Liver Diseases
Mount Sinai Hospital
JA declares that he has no competing interests.
Dr Jawad Ahmad would like to gratefully acknowledge Dr Brian L. Pearlman, the previous contributor to this topic.
BLP is on the speakers' bureaus and serves as an advisor to Merck, Gilead, J&J, and AbbVie, and does contracted research with Boehringer Ingelheim, Tibotec/Janssen, Bristol-Myers Squibb, Gilead, and Merck. BLP is also an author of a number of references cited in this topic. BLP wishes to acknowledge Chaithanya Mallikarjun, MD, for her help in writing the original version of the manuscript.
Digestive Disease and Liver Transplant
AL has participated in an advisory board meeting with Gilead and Janssen, and is a primary investigator for Merck’s C-Surfer trial.
Director of Hepatology and Medical Director of Liver Transplantation
Associate Professor of Medicine
Strong Memorial Hospital
University of Rochester
BM belongs to the paid speaker’s bureau for pharmaceutical companies Gilead (maker of ledipasvir/sofosbuvir), AbbVie (maker of Viekira Pak® - ombitasvir/paritaprevir/ritonavir and dasabuvir), Merck, and Salix.
Bradford Teaching Hospitals Foundation Trust
SM has received sponsorship and has sat on advisory boards for BMS, Gilead, AbbVie, and Merck.
Nottingham University Hospitals NHS Trust
SR is an advisory board (paid) member for AbbVie, Gilead, Janssen, and MSD.
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