In 2014, the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America launched a website (www.HCVGuidelines.org) for the expeditious formulation and dissemination of evidence-based recommendations for hepatitis C virus (HCV) management. The guidance was developed by a panel of hepatology and infectious diseases HCV experts using an evidence-based review of available information and are updated as needed.
The most recent major update occurred in September 2017, primarily as a result of the approval of new direct-acting antiviral agents (DAAs). The authors summarized these updated recommendations related to antiviral therapy as of May 1, 2018, in a report published in Clinical Infectious Diseases.
The major updates to the HCV guidance website include:
- Treatment with DAAs is strongly recommended for all persons with chronic HCV infection (except those with a short life expectancy who cannot be remediated). Restricting access to DAAs based on certain criteria, including fibrosis stage or recent drug use, is neither evidence based nor patient centered. Certain previously recommended regimens have been downgraded to alternative status because of considerations such as pill burden, use of ribavirin, and/or longer duration.
- As risk factor-based screening has not been shown to be effective, universal testing of pregnant women at the initiation of prenatal care was added to the guidelines.
- Testing and care of key populations at elevated risk for chronic HCV infection, such as people who inject drugs, men who have sex with men, and individuals in jails and prisons are highlighted to reduce HCV transmission and decrease HCV morbidity and mortality.
The authors noted that, “Readers are encouraged to consult the online guidance (www.HCVGuidelines.org) for updated recommendations subsequent to this report, related evidence reviews, and information that addresses other aspects of HCV testing and management.”
AASLD-IDSA HCV Guidance Panel. Hepatitis C guidance 2018 update: AASLD-IDSA recommendations for testing, managing, and treating hepatitis C virus infection [published online September 12, 2018]. Clin Infect Dis. doi: 10.1093/cid/ciy585