The World Health Organization (WHO) has released new guidelines for the care and treatment of persons diagnosed with chronic hepatitis c virus infection coinciding with World Hepatitis Day. The guidelines are an update to April 2016 and aim to provide evidence-based recommendations on the care and treatment of persons diagnosed with chronic HCV infection. The new guidelines will simplify the delivery of curative therapy to the 70 million people living with chronic hepatitis C (HCV) in the world.
Major Recommendations are –
- Offer treatment to all individuals diagnosed with HCV infection who are 12 years of age or older, irrespective of disease stage.
- In children aged less than 12 years, the guidelines advise that interferon-based regimens should no longer be used.
- Exceptional treatment with interferon and ribavirin may be considered for children with genotype 2 or 3 infection and severe liver disease.
- Pangenotypic DAA regimens are recommended for the treatment of people with chronic HCV infection aged 18 years and above.In adolescents aged 12-17 years or weighing at least 35kg, the WHO recommends:
- sofosbuvir/ledipasvir for 12 week in genotypes 1, 4, 5 and 6;
- sofosbuvir/ribavirin for 12 weeks in genotype 2; and
- sofosbuvir/ribavirin for 24 weeks in genotype 3
- In children aged less than 12 years with chronic hepatitis C, defer treatment until 12 years of age**.
- Existing recommendation from the 2016 HCV treatment guidelines (2)An alcohol intake assessment is recommended for all persons with HCV infection followed by the offer of a behavioural alcohol reduction intervention for persons with moderate-to-high alcohol intake. (Strong recommendation, moderate quality of evidence).
- Existing recommendation from the 2016 HCV treatment guidelines (2) In resource-limited settings, it is suggested that aminotransferase /platelet ratio index (APRI) or FIB-4 be used for the assessment of hepatic fibrosis rather than other non-invasive tests that require more resources such as elastography or FibroTest.
- Existing recommendation from the 2017 hepatitis B and C testing guidelines (3)Nucleic acid testing for qualitative or quantitative detection of HCV RNA should be used as a test of cure at 12 or 24 weeks (i.e. sustained virological response [SVR12 or SVR24])
after completion of antiviral treatment.
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Dr. Kamal Kant Kohli
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