Treatment guidelines for hepatitis C virus (HCV) are constantly evolving. Clinicians should frequently refer to the most recent recommendations of the American Association for the Study of Liver Diseases (AASLD) and Infectious Diseases Society of America (ISDA).
Not all patients will be able to receive treatment immediately after the approval of new treatment options; therefore, priority needs to be given to those with the most urgent need.
The highest priority patients include those that are liver transplant recipients, at high risk for liver-related complications, have advanced fibrosis, have compensated cirrhosis, and have severe extraheptic complications.
For patients with high risk of HCV transmission, treatment decisions need to balance the anticipated reduction in transmission with the likelihood that a reinfection might occur. Patients who have a high risk of HCV transmission include men who have high-risk sex with other men, active injection drug users, incarcerated persons, and persons on hemodialysis.
There are two goals behind the treatment of chronic HCV. One is to achieve sustained eradication of the virus. This is defined by the persistent absence of HCV RNA in serum 12 weeks after completing antiviral treatment. The other goal is to prevent the infection from progressing to cirrhosis, hepatocellular carcinoma (HCC), or decompensated liver disease that requires a liver transplant.
One form of treatment for chronic hepatitis C is antiviral therapy. The decision to choose this treatment option needs to be decided on a case-by-case basis, although the treatment is recommended for patients with elevated serum alanine aminotransferase (ALT) levels. For these patients, they must meet the following criteria:
- Be older than 18 years of age
- Have positive HCV antibody and serum HCV RNA test results
- Have compensated liver disease
- Have acceptable hematologic and biochemical indices
- Be willing to receive treatment and capable of adhering to treatment requirements
- Have no contraindications for treatment
- Have a liver biopsy that is consistent with the diagnosis of chronic hepatitis C (however, the biopsy doesn’t need to be done prior to treatment)
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