Autumn begins with an update to the AASLD/IDSA/IAS-USA hepatitis C guidelines: Guidance, Monitoring Patients Who Are Starting HCV Treatment, Are On Treatment, Or Have Completed Therapy. It is divided into 3 parts:
- Pretreatment and on-treatment monitoring
- Post-treatment follow-up for persons in whom treatment has failed to clear virus
- Post-treatment follow-up for those who achieved a sustained virologic response (SVR; virologic cure)
Below is a synopsis, taken directly from www.hcvguidelines.org.
PRETREATMENT AND ON-TREATMENT MONITORING
Recommended Assessments Prior to Starting Antiviral Therapy
- Assessment of potential drug-drug interactions with concomitant medications is recommended prior to starting antiviral therapy.
The following laboratory tests are recommended within 6 weeks prior to starting antiviral therapy:
- Complete blood cell (CBC) count; international normalized ratio (INR)
- Hepatic function panel (albumin, total and direct bilirubin, alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase levels)
- Thyroid-stimulating hormone (TSH; if interferon is used)
- Calculated glomerular filtration rate (GFR)
- The following laboratory test is recommended within 12 weeks of starting antiviral therapy:
- HCV genotype and quantitative HCV viral load
Recommended Monitoring during Antiviral Therapy
- CBC count, creatinine level, calculated GFR, and hepatic function panel are recommended every 4 weeks during antiviral therapy. TSH is recommended every 12 weeks for patients on IFN. More frequent assessment for drug-related toxic effects (eg, CBC count for patients receiving RBV) is recommended as clinically indicated.
- Quantitative HCV viral load testing is recommended after 4 weeks of therapy, at the end of treatment, and at 12 weeks following completion of therapy.
- Quantitative HCV viral load monitoring at 4 weeks is recommended, but discontinuation of treatment because this test result is missing is NOT recommended.
POST-TREATMENT FOLLOW-UP FOR THOSE WHO ACHIEVED A SUSTAINED VIROLOGIC RESPONSE (SVR)
- For patients who do not have advanced fibrosis (ie, those with Metavir F0, F1, or F2), recommended follow-up is the same as if they were never infected with HCV.
- Assessment for HCV recurrence or reinfection is recommended only if the patient has ongoing risk for HCV infection or otherwise unexplained hepatic dysfunction develops. In such cases, a quantitative HCV RNA assay rather than an anti-HCV serology test is recommended to test for HCV recurrence or reinfection.
- Surveillance for hepatocellular carcinoma with twice yearly ultrasound testing is recommended for patients with advanced fibrosis (ie, Metavir F3 or F4), who achieve an SVR.
- A baseline endoscopy is recommended to screen for varices if cirrhosis is present. Patients in whom varices are found should be treated and followed up as indicated.
- Assessment of other causes of liver disease is recommended for patients who develop persistently abnormal liver tests after achieving an SVR.
- Routine assessment for regression in liver fibrosis after achieving SVR is NOT recommended.
POST-TREATMENT FOLLOW-UP FOR PERSONS IN WHOM TREATMENT HAS FAILED TO CLEAR VIRUS
- Disease progression assessment every 6 months to 12 months with a hepatic function panel, CBC count, and INR is recommended.
- Surveillance for hepatocellular carcinoma with ultrasound testing every 6 months is recommended for patients with more advanced fibrosis (ie, Metavir F3 or F4).
- Endoscopic surveillance for esophageal varices is recommended if cirrhosis is present.
- Evaluation for retreatment is recommended as effective alternative treatments become available.
- Monitoring for HCV drug resistance-associated variants (RAVs) on and after therapy is NOT recommended.
Now we wait for the announcement of ledipasvir/sofosbuvir