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Updated WHO Guidelines for the Screening, Care and Treatment of Persons with Hepatitis C Infection

In April 2016, WHO updated its "Guidelines for the screening, care and treatment of persons with chronic hepatitis C". Since 2014, several new medicines for the treatment of HCV infection have been introduced. These medicines are transforming the treatment of HCV, enabling the use of regimens that can be administered orally, are shorter in duration (as short as eight weeks), result in cure rates higher than 90%, and are associated with fewer serious adverse events (SAEs) than the previous interferon-containing regimens.

The objectives of these guidelines are to provide evidence-based recommendations for the treatment of persons with hepatitis C infection using, where possible, all-oral combinations of these new medicines, also called direct-acting antivirals (DAAs). The Guidelines also provide recommendations on the preferred regimens based on a patient’s HCV genotype and clinical history, and assess the appropriateness of continued use of the existing medicines.

The key audience for these guidelines are policy-makers in low- and middle-income countries who formulate country-specific treatment guidelines, and who plan infectious disease treatment programmes and services, in addition to those people responsible for delivering treatment. The Guidelines are appropriate for all countries, including high-income countries.

Summary of key recommendations

Recommendations on screening for HCV infection

1. Screening to identify persons with HCV infection
It is recommended that HCV serology testing be offered to individuals who are part of a population with high HCV prevalence or who have a history of HCV risk exposure/ behaviour.

2. When to confirm the diagnosis of chronic HCV infection
It is suggested that following a positive HCV virus serological test another test (NAT for the detection of HCV RNA) be performed to diagnose chronic infection. NAT for HCV RNA should also be performed to assess whether to start treatment for hepatitis C.

Recommendations on care of people infected with HCV

3. Screening for alcohol use and counselling to reduce moderate and high levels of alcohol intake
An alcohol intake assessment is recommended for all persons with HCV virus infection followed by the offer of a behavioural alcohol reduction intervention for persons with moderate-to-high alcohol intake.

4. Assessing degree of liver fibrosis and cirrhosis
In resource-limited settings, the aminotransferase/platelet ratio index (APRI) or FIB4 tests should be used for the assessment of hepatic fibrosis rather than other non-invasive tests that require more resources such as elastography or fibrotest.

Recommendations on hepatitis C treatment

5. Assessing for HCV treatment
All adults and children with chronic HCV infection should be assessed for antiviral treatment.

6. Treatment with direct-acting antivirals (DAAs)
WHO recommends that all patients with hepatitis C be treated with DAA-based regimens, except for a few specific groups of people in whom interferon-based regimens can still be used (as an alternative regimen for patients with genotype 5 or 6 infection and those with genotype 3 HCV infection who also have cirrhosis).

7. Telaprevir and boceprevir should no longer be used
These 2 first-generation DAAs, which are administered with pegylated interferon and ribavirin, were recommended in the 2014 guidelines. Evidence now shows that they result in more frequent adverse effects and less frequent cures compared with newer DAA-based regimens. Thus, these 2 medicines are no longer recommended by WHO.

8. WHO recommends preferred and alternative DAA regimens based on genotype and cirrhosis status
The Guideline Development Group reviewed all the available data (over 200 studies) to determine which regimens were most effective and safen anglais pour le moment ici.

These guidelines are available in english here :