Background
Multiple studies have shown that successful antiviral therapy of chronic hepatitis C virus (HCV) infection dramatically reduces both liver-related morbidity (including rates of end-stage liver disease and hepatocellular carcinoma) and mortality, as well as all-cause mortality.[1,2,3,4] Direct-acting antiviral (DAA) treatment for HCV has proven to be much safer, better tolerated, and more effective than treatments used in the interferon era, now rendering the decision to initiate therapy much easier. The AASLD-IDSA HCV Guidance notes that evidence clearly supports treatment of nearly all persons with chronic HCV infection.[5] Decisions regarding initiating therapy will naturally be influenced by the individual’s willingness and readiness to undertake treatment.
Generally Accepted Indicators for Treatment
The AASLD-IDSA HCV Guidance previously provided a priority ranking for treatment based on clinical factors and public health considerations.[5] This priority ranking arose, in part, due to the relatively limited infrastructure capable of treating the surge of persons with chronic HCV infection who had been waiting to receive treatment with new DAA therapy.[5] This treatment priority ranking is no longer used in the AASLD-IDSA HCV Guidance; instead, the current guidance emphasizes that all persons, except for those with a short (i.e. less than 12 months) life expectancy, should receive treatment for chronic HCV infection.[5] The recommendation to treat virtually all persons with chronic HCV infection stems from multiple factors, including the very high sustained virologic response (SVR) rates with current DAA therapy, the safety and tolerability of DAA therapy, and the preponderance of data demonstrating benefit across a spectrum of clinical outcomes with achievement of SVR.[5,6] The AASLD-IDSA HCV Guidance also addresses the following unique populations that may require special considerations when weighing treatment decisions:[5]
- Persons with HCV and HIV coinfection
- Persons with HCV who have decompensated cirrhosis
- Persons who develop HCV post-liver transplantation
- Persons with HCV and renal impairment
- Persons with HCV who are post-renal transplantation
- Persons with acute HCV infection
- Pregnant women with HCV
- Children with HCV