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Updated WHO Hepatitis C Treatment Guidelines

Geneva - July 2018

The World Health Organization released the updated Guidelines for the Care and Treatment of Persons Diagnosed with Chronic Hepatitis C Virus Infection. They follow and update the screening and care section of the WHO Guidelines for the screening, care and treatment of persons with hepatitis C infection, previously issued in April 2014 and April 2016, and update the testing section of the 2017 Guidelines on hepatitis B and C testing.

Key changes include:

  • Usage of safe and highly effective direct-acting antiviral (DAA) for all persons aged 12 or older, irrespective of disease stage - this includes treatment for individuals with little or no fibrosis;
  • New pangenotypic DAAs have been approved, reducing the need for genotyping to guide treatment decisions - this achieves treatment efficacy for all six major HCV genotypes;
  • Usage of pangenotypic DAA regimens for treatment of chronic HCV infection for all persons aged 18 years or older.

For adults without cirrhosis, the following pangenotypic regimens can be used:

Sofosbuvir/velpatasvir 12 weeks
Sofosbuvir/daclatasvir 12 weeks
Glecaprevir/pibrentasvir 8 weeks

For adults with compensated cirrhosis, the following pangenotypic regimens can be used:

Sofosbuvir/velpatasvir 12 weeks
Sofosbuvir/daclatasvir 12 or 24 weeks
Glecaprevir/pibrentasvir 12 weeks

In children aged less than 12 years with chronic HCV infection, WHO recommends:

  • deferring treatment until 12 years of age
  • treatment with interferon-based regimens should no longer be used.

Second line treatments:

  • WHO recommends only one pangenotypic DAA regimen, sofosbuvir/velpatasvir/voxilaprevir (as approved by a stringent regulatory authority) for persons who have previously failed DAA treatment.
  • Glecaprevir/pibrentasvir is also approved for retreatment after failure with:
    - sofosbuvir
    - a protease inhibitor or an NS5A inhibitor (but not both)
  • Expert consultation is recommended for retreatment when these regimes are not available.
  • In the absence of these regimens, expert consultation suggests that extending the initial DAA therapy to 16 or 24 weeks, while at the same time reinforcing adherence, may be an alternative option for retreatment.

Strategies for simplifying diagnostics and service delivery are also included, such as:

  • Comprehensive national planning for the elimination of HCV infection;
  • Simple and standardized algorithms across the continuum of care from testing, linkage to care and treatment;
  • Strategies to strengthen linkage from testing to care, treatment and prevention
  • Integration of hepatitis testing, care and treatment with other services (e.g. HIV services) to increase the efficiency and reach of hepatitis services
  • Decentralized testing and treatment services at primary health facilities or harm reduction sites to promote access to care. This is facilitated by two approaches:
    5a. task-sharing, supported by training and mentoring of health-care workers and peer workers; 5b. a differentiated care strategy to assess needs, with referrals to specialists, as appropriate for patients with complex problems.
  • Community engagement and peer support to promote access to services and linkage to the continuum of care, which includes addressing stigma and discrimination
  • Strategies for more efficient procurement and supply management of quality-assured, affordable medicines and diagnostics;
  • Data systems to monitor the quality of individual care and coverage at key steps along the continuum or cascade of care at the population level.

For more information you can download below the fact sheet edited by Treat Asia and the complete updated WHO guidelines.