Experts at the American Association for the Study for Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) have updated HCVguidelines.org, a website developed in collaboration with the International Antiviral Society-USA (IAS-USA) to provide up-to-date guidance on the treatment of hepatitis C virus (HCV). Based on expanded “real-world” experience with the tolerability and efficacy of newer HCV medications, the section on “When and in Whom to Initiate HCV Therapy” no longer includes tables that offer recommendations on how to prioritize patients for treatment. “When the direct-acting medications were first introduced, all our knowledge about how these drugs worked came from clinical trials. We needed to gain more experience with their safety before we encouraged all infected persons to initiate therapy. We now have that experience,” said panel co-chair David Thomas, MD. According to the guidance, successful hepatitis C treatment results in sustained virologic response—or virologic cure—and thus would benefit nearly all of those chronically infected with HCV. Previously, the panel of experts who write the guidance had prioritized treatment with the direct-acting anti-virals for those with the greatest need, particularly those with severe liver disease. Since the panel’s initial recommendation, there have been opportunities to treat many of the highest-risk patients and to learn more about the new medications. “There are also expanding data on the benefits of HCV treatment for patients with all stages of disease, including mild liver disease,” added panel co-chair Raymond Chung, MD. Because of the cost of the new drugs, or regional availability of appropriate health care providers, a practitioner may still need to decide which patients should be treated first. Additionally, those with short life expectancies unrelated to HCV infection are not recommended for treatment with these newer therapies, according to the guidance. “However, the goal is to treat all patients as promptly as feasible to improve health and to reduce HCV transmission” said panel co-chair Henry Masur, MD. “A good relationship between doctor and patient is crucial to achieving the best outcomes with direct-acting therapies. The physician needs to make an assessment of a patient’s understanding of the treatment goals and provide education on the importance of adherence to the therapy and follow-up care,” added panel co-chair Gary Davis, MD. Visit www.HCVguidelines.org for updates to this and other sections of the guidance.
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