HEALTH SYSTEMS National infectious disease organizations update guidance on hepatitis C

The American Association for the Study of Liver Diseases and the Infectious Diseases Society of America recently released updated guidance on testing, treating, and managing hepatitis C.
The updated guidance, published online in Clinical Infectious Disease on July 23, 2023, is focused on recommendations for addressing nonadherence; treatment options for children as young as 3 years old; hepatitis C virus (HCV)–positive organ donation; eligibility changes for a simplified treatment approach; and therapy in vulnerable populations, including incarcerated persons.
Treatment nonadherenceHCV can be treated with direct acting antivirals (DAA). Though the course of therapy is considered to be complete at 8 or 12 weeks, the guidance specifies that up to 40% of patients do not adhere to their treatment regimen.
To address this, the guidance panel developed a new treatment algorithm for patients that considers the timing and duration of nonadherence. The algorithm is broken down into two categories: interruptions prior to receiving 28 days of DAA therapy and interruptions after receiving 28 or more days of DAA therapy.
For all patients who are first nonadherent to their DAA therapy before 28 days, the panel recommends immediately restarting the course of treatment. If a patient misses 7 or fewer days, no other action is needed. If a patient misses 8 or more days, they should immediately receive an HCV RNA test after restarting therapy. If the test returns a negative reading, the patient should complete the medication for the full duration. If positive, the treatment should be extended by 4 weeks.
For patients whose nonadherence occurs after 28 days of treatment and who miss 7 or fewer days, they can immediately restart DAA and continue for the full duration. If a patient misses 8 to 20 consecutive days, they should immediately restart therapy and receive an HCV RNA test.
A negative test indicates that a patient should complete the full duration of therapy, which can be extended in certain circumstances. A positive test indicates stopping treatment and instead following a separate set of recommendations that is laid out in the retreatment section of the guidance document. Patients who miss 21 consecutive days of therapy or more should follow the same steps as a patient with a positive HCV RNA test.
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