Overview of the management of chronic hepatitis C virus infection
- Sanjiv Chopra, MD, MACP
Sanjiv Chopra, MD, MACP
- Editor-in-Chief — Gastroenterology and Hepatology
- Section Editor — General Hepatology; Gallbladder and Biliary Tract Disease
- Professor of Medicine
- Harvard Medical School
- Senior Consultant in Hepatology
- James Tullis Firm Chief
- Beth Israel Deaconess Medical Center
- Paul J Pockros, MD
Paul J Pockros, MD
- Director, Liver Disease Center, Scripps Clinic
- Clinical Director of Research, Scripps Translational Science Institute
Hepatitis C virus (HCV) can cause both acute and chronic hepatitis. The acute process is self-limited, rarely causes hepatic failure, and usually leads to chronic infection. Chronic HCV infection often follows a progressive course over many years and can ultimately result in cirrhosis, hepatocellular carcinoma, and the need for liver transplantation. (See "Clinical manifestations and natural history of chronic hepatitis C virus infection".)
This topic addresses the general management of patients with chronic HCV infection. Patient selection for treatment and specific treatment regimens are discussed in detail elsewhere. (See "Patient evaluation and selection for antiviral therapy for chronic hepatitis C virus infection" and "Treatment regimens for chronic hepatitis C virus genotype 1 infection in adults" and "Treatment regimens for chronic hepatitis C virus genotypes 2 and 3 infection in adults" and "Treatment regimens for chronic hepatitis C virus genotypes 4, 5, and 6 infection in adults" and "Direct-acting antivirals for the treatment of hepatitis C virus infection".)
Guidelines for the diagnosis and management of hepatitis C virus (HCV) infection were released jointly by the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) in 2014, are continuously updated, and can be accessed at www.hcvguidelines.org . The discussion in this topic is generally consistent with those guidelines.
Other guidelines include treatment recommendations from the European Association for the Study of the Liver (EASL) . World Health Organization (WHO) also released guidelines in 2014 on screening and treatment of HCV, intended primarily for clinicians and policy-makers in low- and middle-income countries .
Links to these and other guidelines can be found below. (See 'Society guideline links' below.)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Recommendations for Testing, Managing, and Treating Hepatitis C. Joint panel from the American Association of the Study of Liver Diseases and the Infectious Diseases Society of America. http://www.hcvguidelines.org/ (Accessed on July 08, 2016).
- European Association for the Study of the Liver. Electronic address: email@example.com. EASL Recommendations on Treatment of Hepatitis C 2016. J Hepatol 2017; 66:153.
- World Health Organization. Guidelines for the screening, care, adn treatment of persons with hepatitis C infection. April 2014. http://apps.who.int/iris/bitstream/10665/111747/1/9789241548755_eng.pdf?ua=1 (Accessed on April 14, 2014).
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- van der Meer AJ, Veldt BJ, Feld JJ, et al. Association between sustained virological response and all-cause mortality among patients with chronic hepatitis C and advanced hepatic fibrosis. JAMA 2012; 308:2584.
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- Kowdley KV, Nelson DR, Lalezari JP, et al. On-treatment HCV RNA as a predictor of sustained virological response in HCV genotype 3-infected patients treated with daclatasvir and sofosbuvir. Liver Int 2016; 36:1611.
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- PATIENT EVALUATION
- Psychosocial issues
- Transmission risk
- Diet and behaviors
- GENERAL MANAGEMENT
- Dose adjustments of medications
- Patients with advanced liver fibrosis or cirrhosis
- ANTIVIRAL THERAPY
- Goals of therapy
- Regimen selection
- MONITORING DURING ANTIVIRAL THERAPY
- Interferon-free regimens
- - Viral monitoring
- - Other monitoring
- - Adherence counseling
- Interferon-containing regimens
- FOLLOW-UP AFTER ANTIVIRAL THERAPY
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS