Last reviewed: June 2020
Last updated: May  2020
13 May 2020

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.[53]

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 pre-treatment assessment, on-treatment monitoring, assessment of response, and follow-up.

The guidelines have also been updated to remove less efficacious, complex alternative regimens.

See Management: approach

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Summary

Definition

History and exam

Other diagnostic factors

  • constitutional symptoms
  • jaundice
  • ascites
  • signs of hepatic encephalopathy
  • extrahepatic manifestations

Risk factors

  • unsafe medical practices
  • intravenous or intranasal drug use
  • blood transfusion or organ transplant
  • heavy alcohol use
  • interleukin (IL)-28B gene polymorphism
  • HIV
  • incarceration/institutionalisation
  • haemodialysis
  • healthcare work
  • tattoos
  • multiple sex partners
  • infected mother (for fetus)
  • male sex

Diagnostic investigations

1st investigations to order

  • hepatitis C virus (HCV)-antibody enzyme immunoassay (EIA)
  • hepatitis C virus (HCV) RNA polymerase chain reaction (PCR)
  • serum aminotransferases
More 1st investigations to order

Investigations to consider

  • viral genotyping
  • non-invasive tests of liver fibrosis or elasticity
  • liver biopsy
  • testing for co-infection
More investigations to consider

Treatment algorithm

Contributors

Professor of Medicine

Division of Liver Diseases

Mount Sinai Hospital

New York

NY

Disclosures

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.

Peer reviewersVIEW ALL

Assistant Professor

Digestive Disease and Liver Transplant

Yale University

CT

Disclosures

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

NY

Disclosures

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.

Consultant Hepatologist

Bradford Teaching Hospitals Foundation Trust

Bradford

UK

Disclosures

SM has received sponsorship and has sat on advisory boards for BMS, Gilead, AbbVie, and Merck.

Consultant Hepatologist

Nottingham University Hospitals NHS Trust

UK

Disclosures

SR is an advisory board (paid) member for AbbVie, Gilead, Janssen, and MSD.

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