Selected articles on viral hepatitis and related issues. This internet file provides an algorithm for the management and treatment of hepatitis c. Burak, curtis cooper, marina klein, alnoor ramji, dan smyth and jordan j. Management of hcv infection is more challenging in patients with hematologic malignancies than in patients without cancer because of a higher rate of progression of fibrosis, more rapid development of cirrhosis, increased viral titers, worse outcome, and exclusion from some cancer andor antiviral treatments. The simplified treatment algorithms provide clear, concise guidance on pretreatment assessment, ontreatment monitoring, assessment of response, and followup. Hepatitis c virus hcv infection is the most common etiology of chronic liver disease in western countries. Apasl consensus statements and management algorithms for. This practice consensus algorithm is based on majority expert opinion of hepatitis b virus and hepatitis c experts at the university of texas md anderson cancer center for the patient population.
This revision august 27, 2018 incorporates updates to treatment regimens for chronic hepatitis c virus hcv infection, including. The aim of antiviral therapy for hepatitis c infection is to eradicate the virus completely in order to prevent chronic disease and subsequent liver damage. Many patients with cirrhosis related to hepatitis c infection develop hepatic neoplasms, and management strategies to deal with this problem are urgently required. In addition, sections on management of hepatitis c in special populations have been updated. Patients with acute hepatitis c are often asymptomatic or have nonspecific symptoms eg, fatigue, anorexia, mild or moderate abdominal pain, lowgrade fever, nausea, andor vomiting that frequently are not recognized as being associated with acute hcv infection.
As a result of shared routes of transmission, coinfection with hiv is a substantial problem, and individuals infected with both viruses have poorer outcomes than do peers infected with one virus. Starred items indicate research conducted by va scientists, funded by the va, or involving va patients. If arup consult does not answer your test selection and interpretation questions, or if youd like to suggest ways to improve content or usability, please leave a message for the arup clinical content team. According to the united states department of health and human services, it is estimated that 2. Diagnosis of acute and chronic hepatitis c antihcv antibodies are detectable in serum or plasma by enzyme immunoassay eia in the vast majority of patients with hcv infection, but eia results may be negative in early acute journal of hepatology 2018 vol. Hepatitis c information division of viral hepatitis cdc. Elimination of hepatitis c virus hcv infection as a public health threat is a goal of the world health organization. Once diagnostic testing for hepatitis c was introduced, it became clear that patients on maintenance hemodialysis mhd had a high prevalence of hcv infection and furthermore that hepatitis c acquisition was occurring in the outpatient dialysis setting. The document should be read in conjunction with the previous document to identify changes. Purpose and overview the federal bureau of prisons bop clinical guidance on evaluation and management of chronic hepatitis c virus hcv infection provides the most current bop recommendations for the treatment of chronic hcv infection in the federal inmate population.
Medication efficacy is now greater than 90%, with a high barrier to resistance. Apasl consensus statements and management algorithms for hepatitis c virus infection. American association for the study of liver diseasesinfectious diseases society of america recommendations for testing, managing, and treating hepatitis c virus infection. Time course of serological markers for hcv infection 27 4. The dotted arrows and shaded boxes represent new treatment algorithms based on viral kinetics. Hepatitis c hepatitis c is a liver disease caused by infection with the hepatitis c virus hcv.
How i treat hepatitis c virus infection in patients with. Initiate antiviral therapy in patients with acute liver failure or in those who have a severe, protracted course i. Negative hbv infectiondiagnostic approach and management algorithm. 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. The discussion in this topic is generally consistent with those guidelines. Since the last consensus conference on the management of chronic viral hepatitis, a number of studies looking at modifications of the standard course of treatment have been published. Krawitt,4 giorgina mielivergani,5 diego vergani,6 and john m. Recommended testing sequence for identifying current. Algorithms for hcv genotype 1 treatmentexperienced patients. Sep 15, 2016 management of hcv infection is more challenging in patients with hematologic malignancies than in patients without cancer because of a higher rate of progression of fibrosis, more rapid development of cirrhosis, increased viral titers, worse outcome, and exclusion from some cancer andor antiviral treatments. 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.
Hepatitis c is a liver infection caused by the hepatitis c virus hcv. Update on the management and treatment of hepatitis c virus. Chronic hepatitis c virus hcv infection affects approximately 1. Hepatitis c management and treatment algorithm this internet file provides an algorithm for the management and treatment of hepatitis c. Topics addressed include universal and riskbased hepatitis c screening, simplified treatment algorithms for treatmentnaive adults without cirrhosis or with compensated cirrhosis, hepatitis c management in the pediatric population, acute hepatitis c testing and management, and transplanta. Hepatitis c online is a free educational website from the university of washington national hepatitis training center. Patients with hcv genotype 1 can also be prescribed a directly acting antiviral, boceprevir or telaprevir, in. This algorithm provides guidance for management of uncomplicated cases of hcv by frontline hcps and indicates when referral to an hcv specialist is warranted. Testing, evaluation, and monitoring of hepatitis c. The algorithm was created to enable more hcps to screen for and manage hcv infection, and thus contribute to its elimination.
Hepatitis b and c infections can lead to chronicity and thereafter sequelae like cirrhosis and hepatocellular carcinoma, which account for majority of hepatitis b and c related deaths. Diagnosis and management of hepatitis c infection in. An algorithm for managing chb was developed by a panel of united states hepatologists in 2004 and subsequently updated in 2006 and 2008. The acute process is selflimited, rarely causes hepatic failure, and usually leads to chronic infection. Most people are asymptomatic, although some will present with complications such as cirrhosis, hepatocellular carcinoma, or liver failure. Hepatitis c virus hcv infection is a major health problem worldwide.
A wallchart for gps summarising clinical guidance for treating hepatitis c virus infection with a checklist for pretreatment assessment of people with hepatitis c virus infection may be viewed and downloaded here pdf 485kb. Current hepatitis c virus hcv infection hcv antibody reactive not detected detected no current hcv infection additional testing as appropriate link to care current hcv infection nonreactive hcv rna. For the hepatitis c treatment algorithm, please click here abstract. Hepatitis infectious disease prediction using classification algorithms article pdf available in research journal of pharmacy and technology 128. Hepatitis a and e, which are water and foodbome infections, are often the cause for sporadic cases or outbreaks of viral hepatitis in india.
The solid arrows and clear boxes represent the standard algorithms. Morbidity and mortality due to hcvrelated endstage liver disease are increasing, just as novel therapeutics arrive with the promise of better cure rates that prevent these complications. Pdf clinical utility of hcv core antigen detection and. Costeffectiveness of strategybased approach to treatment. This decision analytical model study explores the association of different treatment strategies with hepatitis c virus epidemiology and associated mortality among individuals with hepatitis c virus infection in canada and assesses whether canada can achieve hepatitis c virus elimination by 2030. Update on prevention, diagnosis, and treatment of chronic hepatitis b. The asian pacific association for the study of the liver apasl convened an international working party on the apasl consensus statements and management algorithms for hepatitis c virus infection in december, 2010, in order to revise asian pacific association for the study of the liver consensus statements on the diagnosis, management and treatment of hepatitis c virus. Aasldpracticeguidelines diagnosis and management of.
Hepatitis c treatment guidelines select health of sc. Hepatitis c management and treatment algorithm national. Hbv antiviral therapy should be started concurrently with directacting antiviral therapy daa for hcv, according to current local hepatitis c guidelines and under specialist guidance. Algorithm for the management of patients with hepatitis c virus hcv genotype 1 infection on therapy with pegylated interferon and ribavirin. An enormous public health danger lies in the fact that many infected patients are unaware of their diseased state. Management algorithm for genotype 1 hepatitis c virus. All patients treated for chronic hepatitis c virus hcv infection receive dual therapy with peginterferon and ribavirin. Please note that hard copies of this resource are no longer available. Management and treatment of hepatitis c viral infection. Today, most people become infected with the hepatitis c virus by sharing needles or other equipment to inject drugs.
Hepatitis c virus hcv vertical transmission in 12monthold infants born to hcvinfected women and assessment of maternal risk factors. New data on defining hcc risk have emerged for hepatitis b virus,1, 2 hepatitis c virus,3 and autoimmune hepatitis. Federal bureau of prisons evaluation and management of chronic hcv infection clinical guidance january 2018 1 1. Hepatitis c virus hcv infection is a significant health problem worldwide, and is the leading cause of cirrhosis, hepatocellular carcinoma, and liver transplantation in the united states. Overview of cost, reimbursement, and costeffectiveness considerations for hepatitis c treatment regimens. This site addresses the diagnosis, monitoring, and management of hepatitis c. Elevated prevalence of hepatitis c infection in users of united states veterans medical centers dominitz ja, et al. Journal articles on viral hepatitis viral hepatitis and. Hepatitis screening and management hbv and hcv algorithm. Update on prevention, diagnosis, and treatment of chronic. Aasld practice guidances are developed by a panel of experts on a topic, and guidance statements are put forward to help clinicians understand and. Official treatment guidelines are comprehensive and may be most appropriate for experienced treaters of hcv. Hepatitis and other liver diseases american family. The currently recommended therapy of chronic hepatitis c infection is the combination of a pegifn and ribavirin.
Hepatitis c virus infection among reproductiveaged women and children in the united states, 2006 to 2014. Management of infants born to mothers with documented or suspected hcv infection add perinatal hcv exposure to infant problem list at 26 months of age. Vierling7 this guideline has been approved by the american association for the study of liver diseases aasld and represents the position of the. Hepatitis c virus hcv infection, a major cause of chronic liver disease and cirrhosis, is predominantly transmit ted by exposure to blood or body fluids.
There is also a section on the use of hematopoietic growth factors to help manage patients on therapy. A simplified algorithm for the management of hepatitis c. A consensus development conference was held in january 2007. Management algorithm for genotype 1 hepatitis c virus core.
Funding for the hepatitis c guidance project is provided exclusively by aasld and idsa. Pdf apasl consensus statements and management algorithms. Hcv can cause both acute and chronic hepatitis infection, ranging in severity from a mild illness that lasts only a few weeks to a serious, lifelong illness resulting in cirrhosis and liver cancer. Update on the management and treatment of hepatitis c.
Guidelines south african hepatitis c management guidelines 2010. Aasldpracticeguidelines diagnosis and management of autoimmune hepatitis michael p. The effects of chronic infection include cirrhosis, endstage liver disease, and hepatocellular carcinoma. The management of hcv has changed significantly over the last 5 years, as treatments have become simpler and more efficacious. Hepatitis b and c epidemiology in selected population. Hepatitis c virus hcv can cause both acute and chronic hepatitis. This site complies with the honcode standard for trustworthy health. If hepatitis b virus hbv dna levels are also detectable, treatment is determined by hbv dna and alanine aminotransferase levels.
Evaluation and management of chronic hepatitis c virus. Insights into the epidemiology, natural history and pathogenesis of hepatitis c virus infection from studies of infected donors and blood product recipients. Monitoring patients who are starting hcv treatment, are on treatment, or have completed. Treatment of chronic hepatitis c the goal of therapy is to prevent complications and death from hcv infection. Pangenotypic regimens with high cure rates and minimal toxicities have greatly simplified the treatment of hepatitis c virus hcv infection. This aligns with the national academies of science, engineering, and medicines plan to eliminate hepatitis c infection as a us public health burden by 2030. The infection progresses to a chronic state in 80% of patients, whereas the virus clears completely after the acute infection in 20% of patients. Treatment algorithm for the management of hepatitis c in hiv. A treatment algorithm for the management of chronic hepatitis. People from endemic areas asia, africa, or injection drug users and those with highrisk sexual behaviors, are at an increased risk for infection.
Division of infectious diseases, massachusetts general hospital, harvard medical school, boston, massachusetts 02114, usa email. Guidelines for the management of hepatitis c hepatitis, viral a brief overview of hepatic viruses other than c the hepatitis a virus hav infection is usually acquired by the fecaloral route, produces a selflimited disease that does not result in chronic infection or longterm liver disease. For some people, hepatitis c is a shortterm illness but for 70%85% of people who become infected with the hepatitis c. Recommendations from the department of veterans affairs hepatitis c resource center program and the national hepatitis c program of. Current hepatitis c virus hcv infection hcv antibody reactive not detected detected no current hcv infection. This site addresses the diagnosis, monitoring, and management of hepatitis c virus infection. Hepatitis c treatment considerations viral hepatitis and. Acute hepatitis manifested by an acute elevation in liver enzymes with jaundice, ascites, or encephalopathy in a patient without a history of hepatitis is reportable to the public health authorities, as is standard medical practice and aligned with infection control services. Chronic hepatitis b chb continues to be an important public health problem worldwide, including in the united states. Full text the full text of this article is available as a pdf 276k. A small proportion hepatitis c virus hcv infection affects more than 2 million adults 1 and is the leading cause of liverrelated mortality. Recommendations from the department of veterans affairs hepatitis c resource center program and the national hepatitis c program office. This project is funded by the centers for disease control and prevention cdc. Hepatitis c symptoms, diagnosis and treatment bmj best.