Treat all with hepatitis C, World Health Organization recommends

Keith Alcorn
Published:
30 July 2018

Everyone with hepatitis C should receive treatment with a pan-genotypic regimen, the World Health Organization recommends in new guidelines issued in July.

The World Health Organization says that the safety and effectiveness of newer direct-acting antivirals (DAAs) have shifted the balance of risks and benefits towards recommending treatment for all. Furthermore, growing access to lower-cost DAAs is enabling treatment to be rolled out rapidly in some low- and middle-income countries.

The new guidelines update recommendations issued in 2016.

Glossary

compensated cirrhosis

The earlier stage of cirrhosis, during which the liver is damaged but still able to perform most of its functions. See also ‘cirrhosis’ and ‘decompensated cirrhosis’.

The new guidelines recommend:

  • Treatment for everyone 12 years and older diagnosed with hepatitis C. Treatment for children should be deferred until aged 12 or over.
  • Use of a pan-genotypic regimen to avoid the need for genotype testing.
  • Assessment of liver fibrosis by non-invasive tests (APRI or FIB-4).
  • Use of glecaprevir/pibrentasvir for people with chronic kidney disease.
  • Use of HCV RNA or HCV core antigen testing to monitor sustained virologic response 12 weeks after completion of treatment.
  • Re-treatment in cases of treatment failure with sofosbuvir/velpatasvir/voxilaprevir.
  • Use of simplified testing and treatment algorithms, integration of hepatitis C testing and treatment services into other services.

For people without cirrhosis the guidelines recommend the following regimens:

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

For people with compensated cirrhosis:

  • Sofosbuvir/velpatasvir 12 weeks
  • Glecaprevir/pibrentasvir 12 weeks
  • Sofosbuvir/daclatasvir 12 weeks in countries with known genotype 3 prevalence < 5%
  • Sofosbuvir/daclatasvir 24 weeks in countries with known genotype 3 prevalence > 5 %.

Treatment for adolescents (12-17 years) requires genotype testing prior to treatment initiation:

  • Genotypes 1, 4, 5 and 6: sofosbuvir/ledipasvir 12 weeks
  • Genotype 2: Sofosbuvir/ribavirin 12 weeks
  • Genotype 3: Sofosbuvir/ribavirin 24 weeks.