Guidance on When and in Whom to Initiate HCV Therapy

Health care professionals who treat patients with hepatitis C virus can now turn to updated guidance when faced with the decision to prioritize treatment for those who will derive the most benefit.

In August, the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA), in collaboration with the International Antiviral Society-USA (IAS-USA), updated the Recommendations for Testing, Managing and Treating Hepatitis C on HCVguidelines.org to include a new section called “When and in Whom To Initiate HCV Therapy.”

Treatment Prioritization

The AASLD, IDSA and IAS-USA advocate for broad and comprehensive intervention for all patients with HCV, but there is a need to treat some patients before others, experts said during a teleconference launch of the guidance update.

“We can’t possibly treat all 3 million to 4 million people with this disease in the United States, so we have to make some decisions about who to treat,” AASLD panel co-chair Donald M. Jensen, MD, professor of medicine and director of the Center for Liver Diseases at University of Chicago Medical Center, said at the briefing.

From a clinical perspective, HCV patients with severe liver disease are at the top of the list, according to Jensen. Specifically, patients with advanced fibrosis or cirrhosis and those who have had a liver transplant represent the populations with the greatest need for urgent treatment (see Table).

“Those with [a lesser] degree of fibrosis but who have life-threatening complications of liver disease or more systemic manifestations of HCV can also benefit,” he added. “That is how we think of the highest level of urgency.”

Patients with less scarring in the liver and fewer systemic symptoms do not require as immediate or urgent treatment, according to Jensen.

The panelists encouraged clinicians to evaluate each patient’s specific disease stage and risk factors before making treatment options.

“The benefits of curing HCV are clear from the standpoint of individual patients as well as that of the health and welfare of our society. This new guidance will help clinicians determine the best course of therapy for each patient given their unique condition,” IDSA president Barbara Murray, MD, said in a press release.

Updates Address Ongoing Needs

The HCVguidelines.org website was launched Jan. 30. The recommendations were created by a panel of 27 experts spanning hepatology and infectious disease as well as a patient advocate. The guidance has been described as a “living document” that will be updated as frequently as possible to keep pace with ongoing advances in HCV diagnosis and treatment.

Since its launch, the website has garnered 190,000 unique visits and nearly 750,000 page views, according to Murray. “The site has already become a useful tool for those on the front lines of HCV treatment,” she said.

Moving forward, the guidelines will continue to be updated when new information warrants a new chapter, said Henry Masur, MD, chief of the National Institutes of Health critical care medicine department and IDSA Hepatitis Task Force member.

“The main focus was the decision of which patients were eligible for treatment and when,” David L. Thomas, MD, MPH, IDSA panel co-chair and professor of medicine and director of the division of infectious diseases at Johns Hopkins School of Medicine, said during the briefing. “Now things have shifted to which patients in whom these treatments would be effective with the fewest side effects. That’s an important change.”

 

Michael S. Saag 

With so many patients infected with HCV in the United States, there is an increasing need for providers who are up to date on how to treat HCV, according to guidelines co-chair and HCV Next Co-Chief Medical Editor Michael S. Saag, MD.

“We hope to create enough of a workforce to get these people into care and treated and cured. It will be a tall order,” Saag said. “This guidance will help educate those who are experts in new and emerging trends, but also perhaps those who are new to the treatment of HCV on how to handle the number of patients coming our way.” — by Rob Volansky