Risk Factors and Treatment Options for Those Infected with HCV

The AASLD and IDSA HCV Guidance Panel recently released updated guidelines for the treatment of hepatitis C virus (HCV) infection.

The panel, including HDV Next editorial board members Arthur Y. Kim, MD, Michael R. Charlton, MD, and HDV Next Co-Chief Editor Michael S. Saag, MD, reviewed information for the HCV guidance. Sources of information included peer-reviewed research; FDA research and safety information on products; manufacturer information; drug interaction data; prescribing information from FDA-approved products.

The study outlined recommendations for various topics ranging from HCV testing and linkage to care, when and in whom to begin therapy, initial treatment, treating unique patient populations, coinfection with HIV, and acute HCV.

Of those most at-risk for HCV, the panel identified those born between 1945 and 1965 as individuals who should be tested at least once for HCV. Those born between these years are in the baby boomer birth cohort and account for 75 percent of those infected with HCV.

The panel also identifies the following risk factors as those that put patients at higher risk for contracting HCV: injection drug use; intranasal illicit drug use; long-term hemodialysis; getting a tattoo in an unregulated setting; health care, emergency medical, and public safety workers after needle-sticks, sharps or mucosal exposures to HCV-infected blood; children born to HCV-infected women; prior recipients of transfusions or organ transplants; HIV infection; unexplained chronic liver disease and chronic hepatitis including elevated ALT levels; and solid organ donors (deceased and living).

The panel recommends antiviral treatment for anyone diagnosed with chronic HCV infection except for those with limited life expectancy due to “non-hepatic causes.”

The guidelines set forth by the panel also indicate that practitioners should treat those at greatest risk for disease complications before treating those with less advanced disease. To determine who is at greater risk, the panel suggests a biopsy of the liver for assessing hepatic fibrosis stage.

Depending on the stage and type of infection, there are different suggested regimens assigned by the panel for those affected by HCV. For instance, for treatment-naïve patients with HCV genotype 1a, the panel recommends a daily fixed-dose combination of ledipasvir/sofosbuvir (Harvoni) for 12 weeks, a daily fixed-dose combination of paritaprevir/ritonavir/ombitasvir/dasabuvir (Viekira Pak), and weight-based ribavirin for 12 weeks in patients without cirrhosis or 24 weeks in patients with cirrhosis, among other treatments.

“Infection with HCV is considered to be acute during the first 6 months,” the researchers wrote.

The panel recommends the following procedures for treating and diagnosing acute HCV infection: undergoing HCV antibody and HCV RNA testing when acute HCV infection is suspected; regular laboratory monitoring until alanine aminotransferase levels are normal and HCV RNA is undetectable; and counseling to prevent transmission and other “hepatotoxic insults.”