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Latest Hepatitis C Guidelines

Autumn Begins with the Latest Hepatitis C Guidelines

Autumn Begins with the Latest Hepatitis C Guidelines

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

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{ 1 comment… add one }
  • vicki September 28, 2014, 1:24 PM

    Thank You Lucinda for all your useful information. I have been clear since my first month on my 48 week treatment. I go back to Stanford next month for CT scan & Labs, but I do have cirrhosis and worry about HE, So I do like to stay updated and help get people informed. Hope you are still well, and Bless you .

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