HCV Guidelines: Where you find the latest treatment recommendations

AASLD/IDSA HCV Guidance: treatment, monitoring and testing recommendations

 Where do doctors turn to find out the latest treatment recommendations for hepatitis C?  Where do they look to find the latest recommendations for testing for hepatitis C and interpreting what the results mean? Where do doctors look to find out about drugs that may interact or interfere with the hepatitis C treatment?  The answer to these and almost all questions regarding hepatitis C testing, treatment and monitoring can be found not in an esoteric medical journal, but online at HCVguidelines.org.


In 2013, the American Association for the Study of Liver Disease (AASLD)(AASLD link) and the Infectious Disease Society of America (IDSA) (IDSA link) joined forces to create an online guidance document to guide physicians and other health care professionals in hepatitis C treatment. Each society nominated two co-chairs and ten experts who were joined by a fifth co-chair from IAS-USA (IAS-USA link), the organization that produced the online document and kept it updated. The very first online publication appeared on January 29, 2014 (www.HCVguidelines.org) and covered hepatitis C testing, initial treatment and treatment of patients who had failed a prior treatment.  In addition, recommendations were provided for patients with renal disease and HCV, liver transplant patients with HCV, as well as those with HIV and HCV co-infection.

To arrive at the listed recommendations, expert panelist reviewed all the available published literature as well as published presentations from national and international meetings.

The panelists assessed the strength of literature and the importance in making a recommendation. Each recommendation is listed in a box providing a quick way of seeing the preferred and alternate listings. Each boxed recommendation is followed by a narrative discussion of the pertinent literature and the reasons that the committee arrived at the recommendation.The five co-chairs than approved the panel recommendations which were then sent to the governing boards of each society before final approval and listing.

This rigorous approach, undertaken without financial backing of industry, has been regarded as the standard for HCV recommendations by government and insurance payers as well as other academic and policy organizations. The decision to make these guidelines web-based was so that they could be rapidly and nimbly updated as the field changed and new medications were approved by the FDA. Journal publication often necessitates an obligatory 6-12 month processing delay, which in the rapidly evolving field of hepatitis C, would be too long.

Several months later, the guidelines were updated to include sections on the treatment of patients with acute hepatitis C, monitoring hepatitis C treatment, and when and whom to treat. This latter section was particularly important in guiding payers on whom to offer treatment. The initial recommendations in early 2014 prioritized treatment for patients with the most urgent need (advanced fibrosis, cirrhosis, and those with severe non-liver complications) over those with lesser degrees of fibrosis.  This decision was based upon several factors, notably the long waiting list of patients requesting treatment and the fact that even better therapies were anticipated within the year.

As these new therapies became available and data regarding the real life outcomes of patients reflected the outcomes in clinical trials, the recommendations were broadened to include all patients with hepatitis C except those with less than one year of life expectancy. More recently, the panelists added a section on cost-effectiveness analysis and HCV treatment.

These guidelines, technically referred to as a guidance document, have been updated many times since that initial 2014 iteration. In addition, a print form has been published in Hepatology journal in September 2015; this publication offers a snapshot of the recommendations in early 2015, but is a resource for the references, tables and methodology used.

Should patients and other lay people use these recommendations?  Although it is written for medical professionals, many patients may find the information useful in formulating questions about their treatment or other aspects of hepatitis C. However, be sure to share with your health professional where you obtained the information. 

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