First WHO guidelines for screening, care and treatment of persons with hepatitis C infection 9 key recommandations

Expected for a long time from NGOs, the first WHO guidelines for screening, care and treatment of persons with hepatitis C infection have just been issued and presented during the 49th International Liver Congress, on April 10, 2014.

These guidelines are intended for policy makers and implementers from governmental or non-governmental organizations in low and middle income countries, these guidelines aims to suggest a framework for action to implement program to fight HCV.

185 millions of people have been infected by the HCV virus and most of them don’t know their serology. The lack of screening and monitoring is critical to fight HCV. For all countries with limited resources, these guidelines mark a step with the introduction of new direct-acting antiviral agents which can cure more than 90 % of infected people.

These guidelines suggest 9 key recommendations

Recommendations on screening for HCV infection

1. Screening to identify persons with HCV infection: It is recommended that
HCV serology testing be offered to individuals who are part of a population
with high HCV prevalence or who have a history of HCV risk exposure/behaviour.
Strong recommendation, moderate quality of evidence

2. When to confirm the diagnosis of chronic HCV infection: It is suggested that
nucleic acid testing (NAT) for the detection of HCV ribonucleic acid (RNA) be performed directly following a positive HCV serological test to establish the diagnosis of chronic HCV infection, in addition to NAT for HCV RNA as part of the assessment for starting treatment for HCV infection.
Conditional recommendation, very low quality of evidence

Recommendations on care of people infected with HCV

3. Screening for alcohol use and counselling to reduce moderate and high levels of alcohol intake: 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

4. Assessing degree of liver fibrosis and cirrhosis: In resource-limited settings,
it is suggested that the aminotransferase/platelet ratio index (APRI) or FIB4
tests be used for the assessment of hepatic fibrosis rather than other noninvasive
tests that require more resources such as elastography or Fibrotest.
Conditional recommendation, low quality of evidence

Recommendations on treatment of HCV infection

5. Assessing for HCV treatment: All adults and children with chronic HCV infection, including people who inject drugs, should be assessed for antiviral treatment. Strong recommendation, moderate quality of evidence

6. Treatment with pegylated interferon and ribavirin: Pegylated interferon in combination with ribavirin is recommended for the treatment of chronic HCV infection rather than standard non-pegylated interferon with ribavirin.
Strong recommendation, moderate quality of evidence

7. Treatment with telaprevir or boceprevir: Treatment with the direct-acting antivirals telaprevir or boceprevir, given in combination with pegylated interferon and ribavirin, is suggested for genotype 1 chronic HCV infection rather than pegylated interferon and ribavirin alone.
Conditional recommendation, moderate quality of evidence

8. Treatment with sofosbuvir: Sofosbuvir, given in combination with ribavirin with or without pegylated interferon (depending on the HCV genotype), is recommended in genotypes 1, 2, 3 and 4 HCV infection rather than pegylated interferon and ribavirin alone (or no treatment for persons who cannot tolerate interferon).
Strong recommendation, high quality of evidence

9. Treatment with simeprevir: Simeprevir, given in combination with pegylated interferon and ribavirin, is recommended for persons with genotype 1b HCV infection and for persons with genotype 1a HCV infection without the Q80K polymorphism rather than pegylated interferon and ribavirin alone.
Strong recommendation, high quality of evidence

You can download the guidelines here