ID, liver societies update guidance for HCV testing, management

The Infectious Diseases Society of America and the American Association for the Study of Liver Diseases recently updated their guidance on hepatitis C virus (HCV).

The guidance panel first recommended universal HCV screening for all adults in 2019. For initial HCV testing, the guidance panel recommends HCV antibody screening with reflex HCV RNA testing to establish the presence of active infection (as opposed to spontaneous or treatment-induced viral clearance).

“Recommendations without rigorous implementation, however, are ineffectual,” the panel stated. “The COVID pandemic significantly affected HCV screening, diagnosis, and treatment, causing a drop in processed HCV antibody and HCV RNA tests. Studies about how the pandemic affected test rates underscore the critical importance of ongoing, rigorous, universal HCV screening for case identification and linkage to care,” the panel said.

Recognizing that direct-acting antiviral (DAA) treatment for HCV is sometimes incomplete and that this could lead to treatment failure, the guidance includes a new algorithm for the management of incomplete adherence. It considers nonadherence timing and duration, as well as specific patient factors such as genotype 3 infection and compensated cirrhosis. The algorithm applies only to DAA treatment-naive patients and patient populations eligible for the simplified treatment algorithms.

The guidance notes that DAA therapy is safe, effective, relatively short, and curative in most people and that widespread use could substantially reduce the prevalence of HCV. One major change in the updated guidance is shortening the duration of glecaprevir/pibrentasvir therapy to eight weeks for persons with compensated cirrhosis, which is supported by the findings from the international, single-arm, open-label, phase 3b EXPEDITION-8 clinical trial, the panel stated.

The guidance was published May 25 in Clinical Infectious Diseases.