Guideline on treatment of chronic hepatitis C virus
Purpose of this Guideline
HCV Guideline Committee, updated June 2020
This guideline on treatment of chronic hepatitis C virus (HCV) infection was developed by the New York State (NYS) Department of Health (DOH) AIDS Institute (AI) to guide primary care providers and other practitioners in NYS in treating patients with chronic HCV infection. The guideline aims to achieve the following goals:
- Promote universal screening for HCV.
- Increase the number of NYS residents with chronic HCV infection treated for and cured of HCV.
- Increase compliance with the 2014 NYS public health law that requires HCV antibody screening be offered to every individual born between 1945 and 1965 who receives healthcare services from a physician, physician assistant, or nurse practitioner in a primary care or inpatient hospital setting.
- Reduce the growing burden of morbidity and mortality associated with chronic HCV infection.
- Integrate current evidence-based clinical recommendations into the HCV-related implementation strategies of the Ending the Epidemic (ETE) Initiative, which seeks to end the AIDS epidemic in NYS by the end of 2020.
The NYSDOH AI is publishing these guidelines at a critical time: 1) new treatments are available that can cure chronic HCV infection; 2) the burden of HCV disease is increasing in NYS [CDC 2016]; and 3) primary care providers and other clinical care practitioners in NYS are playing an essential role in screening for and diagnosing chronic HCV infection and in providing state-of-the-art therapy for their patients.
New Standard of Care for Treatment of Chronic HCV Infection
The availability of safe and effective regimens of oral direct-acting antivirals (DAAs) has revolutionized HCV care. New DAA agents and new combinations of agents continue to be tested and approved, and these efficacious combinations have replaced earlier treatments as the standard of care for curing chronic HCV infection. The DAA regimens make cure possible for many patients, but these patients must first be identified, engaged in care, offered appropriate screening for status of their HCV infection/disease, and have access to treatment.
The goal of HCV therapy is a sustained virologic response (SVR), which is defined as the absence of detectable HCV RNA at least 12 weeks after completion of therapy. An SVR is the equivalent of cure. DAA regimens have been associated with an SVR rate of more than 90% and have excellent tolerability in both treatment-naive and treatment-experienced patients with and without cirrhosis [Falade-Nwulia et al. 2017].
CDC. Multiple cause of death 1999-2015 on CDC WONDER online database. 2016 Dec. https://wonder.cdc.gov/
Falade-Nwulia O, Suarez-Cuervo C, Nelson DR, et al. Oral Direct-Acting Agent Therapy for Hepatitis C Virus Infection: A Systematic Review. Ann Intern Med 2017;166(9):637-4