Treat all with hepatitis C, World Health Organization recommends

30 Jul 2018 Keith Alcorn
Originally published on www.infohep.org

Everyone with hepatitis C should receive treatment with a pan-genotypic regimen, the World Health Organization recommends in new guidelines issued in July.

The World Health Organization says that the safety and effectiveness of newer direct-acting antivirals (DAAs) have shifted the balance of risks and benefits towards recommending treatment for all. Furthermore, growing access to lower-cost DAAs is enabling treatment to be rolled out rapidly in some low- and middle-income countries.

The new guidelines update recommendations issued in 2016.

The new guidelines recommend:

  • Treatment for everyone 12 years and older diagnosed with hepatitis C. Treatment for children should be deferred until aged 12 or over.
  • Use of a pan-genotypic regimen to avoid the need for genotype testing.
  • Assessment of liver fibrosis by non-invasive tests (APRI or FIB-4).
  • Use of glecaprevir/pibrentasvir for people with chronic kidney disease.
  • Use of HCV RNA or HCV core antigen testing to monitor sustained virologic response 12 weeks after completion of treatment.
  • Re-treatment in cases of treatment failure with sofosbuvir/velpatasvir/voxilaprevir.
  • Use of simplified testing and treatment algorithms, integration of hepatitis C testing and treatment services into other services.

For people without cirrhosis the guidelines recommend the following regimens:

  • Sofosbuvir/velpatasvir 12 weeks
  • Sofosbuvir/daclatasvir 12 weeks
  • Glecaprevir/pibrentasvir 8 weeks.

For people with compensated cirrhosis:

  • Sofosbuvir/velpatasvir 12 weeks
  • Glecaprevir/pibrentasvir 12 weeks
  • Sofosbuvir/daclatasvir 12 weeks in countries with known genotype 3 prevalence < 5%
  • Sofosbuvir/daclatasvir 24 weeks in countries with known genotype 3 prevalence > 5 %.

Treatment for adolescents (12-17 years) requires genotype testing prior to treatment initiation:

  • Genotypes 1, 4, 5 and 6: sofosbuvir/ledipasvir 12 weeks
  • Genotype 2: Sofosbuvir/ribavirin 12 weeks
  • Genotype 3: Sofosbuvir/ribavirin 24 weeks.