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TitleWHO. Guidelines for the screening, care and treatment of person
LanguageEnglish
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Total Pages122
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Page 1

C
GUIDELINES FOR THE SCREENING,
CARE AND TREATMENT OF PERSONS
WITH HEPATITIS C INFECTION
APRIL 2014

GUIDELINES

Global Hepatitis Programme
Department of HIV/AIDS

20, avenue Appia
1211 Geneva 27
Switzerland

E-mail: [email protected]

http://www.who.int/hiv/topics/hepatitis/en/

978 92 4 154875 5

GUIDELINES FOR THE SCREENING, CARE AND TREATM
ENT OF PERSONS W

ITH HEPATITIS C INFECTION

Page 2

GUIDELINES

GUIDELINES FOR THE SCREENING,
CARE AND TREATMENT OF PERSONS
WITH HEPATITIS C INFECTION
APRIL 2014

Page 61

62

Implementation considerations

The calculation of the APRI score should be easy to implement as it relies on tests

that are available in most clinics. Evaluation of the results is more challenging

because of the need to assess two cut-off values. However, the above-mentioned

strategy provides an approach that should be feasible and will allow clinicians to

decide who should be treated. As persons with advanced fibrosis and cirrhosis

(METAVIR F3 and F4 stages) are at highest risk of dying from complications of

HCV, they need to be prioritized for treatment. If resources allow, treatment of

persons with less advanced stages of cirrhosis could be considered.

Page 62

63

7. RECOMMENDATIONS ON TREATMENT

7.1 Assessment 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

Background

Over the past two decades, the success of treatment for HCV infection as

measured by SVR has steadily increased. Early treatments with standard IFN

resulted in SVR rates of 30–60% depending on the genotype. The introduction

of PEG-IFN increased SVR rates to 40–70%, and the more recent introduction

of direct-acting antivirals (DAAs) increased the SVR rate for genotype 1 from

40% to greater than 90%. Despite these advances, very few persons in low-

and middle-income countries have been treated for HCV infection. The reasons

for this are many and include the high cost of treatment, requirement for

expensive laboratory equipment and tests to evaluate eligibility for and response

to treatment, and lack of health-care workers trained in administering treatment

for HCV infection. Regimens based on PEG-IFN and RBV also result in high rates

of adverse events, which can be debilitating and even life threatening. Thus, the

Guidelines Development Group felt it important to evaluate the relevant evidence

of the benefits and harms of treatment versus no treatment of HCV infection.

Evidence

A systematic review was conducted to investigate the utility of treatment versus

no treatment for HCV infection in adults and children. The outcome measures

were rates of SVR, decompensated liver disease, HCC, liver-related and all-

cause mortality, treatment-related adverse events leading to discontinuation and

quality of life.

Page 121

122

217. Potthoff A, Wedemeyer H, Boecher WO, Berg T, Zeuzem S, Arnold J, et

al. The HEP-NET B/C co-infection trial: A prospective multicenter study

to investigate the efficacy of pegylated interferon-alpha2b and ribavirin in

patients with HBV/HCV co-infection. J Hepatol. 2008;49(5):688–94.

218. Pérez-Elías MJ, García-San Miguel L, González García J, Montes Ramírez

ML, Muriel A, Machín-Lázaro JM, et al. Tuberculosis complicating hepatitis

C treatment in HIV-infected patients. Clin Infect Dis. 2009;48(8):e82–5.

doi: 10.1086/597503.

219. Gilks CF, Crowley S, Ekpini R, Gove S, Perriens J, Souteyrand Y, et al. The

WHO public-health approach to antiretroviral treatment against HIV in

resource-limited settings. Lancet. 2006;368(9534):505–10.

Page 122

C
GUIDELINES FOR THE SCREENING,
CARE AND TREATMENT OF PERSONS
WITH HEPATITIS C INFECTION
APRIL 2014

GUIDELINES

Global Hepatitis Programme
Department of HIV/AIDS

20, avenue Appia
1211 Geneva 27
Switzerland

E-mail: [email protected]

http://www.who.int/hiv/topics/hepatitis/en/

978 92 4 154875 5

GUIDELINES FOR THE SCREENING, CARE AND TREATM
ENT OF PERSONS W

ITH HEPATITIS C INFECTION

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