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Summary of Recommendations for When and in Whom to Initiate HCV Therapy
 

Goal of Treatment

  • The goal of treatment of HCV-infected persons is to reduce all-cause mortality and liver-related health adverse consequences, including end-stage liver disease and hepatocellular carcinoma, by the achievement of virologic cure as evidenced by a sustained virologic response.
    Rating: Class I, Level A

     

Recommendations for When and in Whom to Initiate Treatment

  • Treatment is recommended for all patients with chronic HCV infection, except those with short life expectancies that cannot be remediated by treating HCV, by transplantation, or by other directed therapy. Patients with short life expectancies owing to liver disease should be managed in consultation with an expert.
    Rating: Class I, Level A

     

Recommendations for Pretreatment Assessment

  • Evaluation for advanced fibrosis using liver biopsy, imaging, and/or noninvasive markers is recommended for all persons with HCV infection, to facilitate an appropriate decision regarding HCV treatment strategy and to determine the need for initiating additional measures for the management of cirrhosis (eg, hepatocellular carcinoma screening). (see HCV Testing and Linkage to Care)
    Rating: Class I, Level A

     

Recommendations for Repeat Liver Disease Assessment

  • Ongoing assessment of liver disease is recommended for persons in whom therapy is deferred.
    Rating: Class I, Level C

When and in Whom to Initiate HCV Therapy Table 1. Factors Associated With Accelerated Fibrosis Progression

Host

Viral

Nonmodifiable
Fibrosis stage
Inflammation grade
Older age at time of infection
Male sex
Organ transplant

Modifiable
Alcohol consumption
Nonalcoholic fatty liver disease
Obesity
Insulin resistance

HCV genotype 3
Coinfection with hepatitis B virus or HIV

 

Changes made July 6, 2016.