Hepatitis C Treatment Guidance Document Updated- Who to Test, Who to Treat, and With What?

hepatitis-cShould you get tested for Hepatitis C? If you have Hepatitis C, should you start treatment? If you start treatment, which drugs should you take?

There is an update to the 2014 guidelines published by the American Association for the Study of Liver Diseases (AASLD), in partnership with the Infectious Diseases Society of America (IDSA) and in collaboration with the International Antiviral Society-USA (IAS-USA), who created the online Recommendations for Testing, Managing, and Treating Hepatitis C. You can find and read those here…

These new guidelines are published in the journal Hematology “Hepatitis C Guidance: AASLD-IDSA Recommendations for Testing, Managing, and Treating Adults Infected with Hepatitis C Virus.”

 

WHO SHOULD BE TESTED?

  • Those born between 1945 and 1965
  • Yearly for IV drug users and HIV positive men who have unprotected sex with men
  • Those with evidence of liver disease that does not have an explanation (I added this one)

HOW TO TEST?

  • Blood for AST (aspartate transaminase), ALT (alanine transaminase), platelets
  • Fibrosis can be assessed by “vibrations controlled transient liver elastography”
  • Liver biopsy
  • HCV antibody (presence of anti-HCV means current infection, past infection or a false positive)
  • Confirm those with anti-HCV by getting a nucleic acid test (NAT) with detection down to 25 IU/mL
  • If you may have been infected in past 6 months, or are immunocompromised, use NAT.

 

Those who are positive by NAT and have evidence of liver disease should start treatment with antiviral medications. If you have been diagnosed with Hepatitis C, you might be wondering why your doctor has not referred you to a specialist or why your specialist has not started treatment. The reason is that sometimes your own immune system will take care of this virus. Not everyone who is infected will need treatment. If, however, your liver is showing signs that the virus is causing damage, then you should consider starting the anti-viral medications.

The choice of which treatment regimen to take is made by your physician based on either their experience, or based on guidelines. This article and web site presented here offers specific treatment guidelines based on your genotype of the Hepatitis C. I’m aware that these newer Hepatitis C medications are extremely expensive, so I was wondering if there might be industry bias injected into these guidelines. Bias is possible as the article points out that only 51% of the panel making these recommendations must have minimal ties to industry, but even those 51% without direct ties to industry can have influences such as the industry supports their institution or they can be involved in advisory boards or data safety boards effectively making it possible for most of the doctors involved in the creation of this document being influenced by the manufacturers of these very expensive medications.

Despite the potential for bias and pharma directed protocols, the treatment results have been impressive, the duration of treatment much shorter with the newer medications and the side effects significantly reduced. For treatment guidelines, I refer you to the specific document with these guidelines which can be found here…

 

 

Dr. Paul

 

 

 

 

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