The Evolving Management of Hepatitis C Virus
The Evolving Management of Hepatitis C Virus
The CDC recommends that HCV testing be performed in all persons born between 1945 and 1965. Additionally, anyone who is at increased risk for acquiring HCV because of high-risk behavior and/or exposure should be tested at least one time. Serology screening may be used to determine the presence of HCV antibodies, or an assay that detects HCV RNA may be employed. The HCV antibody test is the recommended initial screening mechanism for the vast majority of patients. HCV antibody testing may yield false-negative results, and a repeat test or HCV RNA testing should be considered in patients with recent HCV exposure (i.e., <6 months) and/or immunocompromising conditions. For patients in whom antiviral therapy will be initiated, quantitative HCV RNA testing is recommended to establish a baseline level of viremia prior to therapy. Patients with HCV should be evaluated for hepatitis B and HIV. Patients should also be assessed for the presence of cirrhosis, as this will determine the need for additional screening, such as for HCC. The interpretation of HCV test results is outlined in Table 1 .
The American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA), in collaboration with the International Antiviral Society–USA (IAS–USA), recommend treatment for all HCV-infected individuals, excepting those not expected to have long-term survival owing to non-HCV comorbidities. This guidance, which is based on evidence for treatment with recently approved oral anti-HCV medications, is a change from previous recommendations, which were limited by the number of viable treatment options and their toxicities and poor tolerability. Immediate initiation of antiviral therapy is suggested for patients with cirrhosis, advanced fibrosis, extrahepatic HCV manifestations, or previous liver transplantation. Laboratory testing, which is recommended prior to initiation of treatment, includes HCV RNA levels (including HCV genotype), CBC, liver function tests (LFTs), and markers of kidney function. See Table 1. .
Testing Recommendations and Test Interpretation
The CDC recommends that HCV testing be performed in all persons born between 1945 and 1965. Additionally, anyone who is at increased risk for acquiring HCV because of high-risk behavior and/or exposure should be tested at least one time. Serology screening may be used to determine the presence of HCV antibodies, or an assay that detects HCV RNA may be employed. The HCV antibody test is the recommended initial screening mechanism for the vast majority of patients. HCV antibody testing may yield false-negative results, and a repeat test or HCV RNA testing should be considered in patients with recent HCV exposure (i.e., <6 months) and/or immunocompromising conditions. For patients in whom antiviral therapy will be initiated, quantitative HCV RNA testing is recommended to establish a baseline level of viremia prior to therapy. Patients with HCV should be evaluated for hepatitis B and HIV. Patients should also be assessed for the presence of cirrhosis, as this will determine the need for additional screening, such as for HCC. The interpretation of HCV test results is outlined in Table 1 .
The American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA), in collaboration with the International Antiviral Society–USA (IAS–USA), recommend treatment for all HCV-infected individuals, excepting those not expected to have long-term survival owing to non-HCV comorbidities. This guidance, which is based on evidence for treatment with recently approved oral anti-HCV medications, is a change from previous recommendations, which were limited by the number of viable treatment options and their toxicities and poor tolerability. Immediate initiation of antiviral therapy is suggested for patients with cirrhosis, advanced fibrosis, extrahepatic HCV manifestations, or previous liver transplantation. Laboratory testing, which is recommended prior to initiation of treatment, includes HCV RNA levels (including HCV genotype), CBC, liver function tests (LFTs), and markers of kidney function. See Table 1. .
