French health authorities have recommended that everyone
diagnosed with hepatitis C should be treated with a pangenotypic direct-acting
antiviral combination by a general practitioner unless they have severe liver
disease, coinfection or kidney disease and need to be referred to a liver
The new guidance is intended to simplify testing and
treatment initiation and speed progress towards the target of eliminating
hepatitis C in France by 2030. The guidance has been issued by the Haute
de Santé, the French national authority for health technology assessment
and development of healthcare guidelines.
The guidance recommends that everyone who has been at risk
of hepatitis C exposure should be tested for hepatitis C.
A non-invasive test, used instead of a biopsy, to measure the stiffness
or elasticity of the liver using an ultrasound probe.
The Haute Autorité de Santé says that recommendations for
testing are likely to change after a heath economic assessment is completed. A cost-effectiveness
study by Sylvie Deuffic-Burban and colleagues found that universal
screening was the most cost-effective strategy for France if everyone was
treated immediately, regardless of liver disease stage.
Everyone who tests positive for hepatitis C antibodies should be
tested for chronic HCV infection using an RNA test. Everyone diagnosed with
chronic infection should be assessed for:
fibrosis (using blood tests or Fibroscan)
overweight or obesity, diabetes, metabolic
HBV and / or HIV co-infection;
severe renal insufficiency
All patients with high alcohol consumption, obesity,
metabolic syndrome or diabetes, severe renal insufficiency (estimated glomerular
filtration rate eGFR <30 ml / min / 1.73 m²), a prior history of hepatitis C
treatment or coinfection with hepatitis B or HIV, or with severe liver disease
should be referred for specialist management.
All other patients should be managed by the general
practitioner. HCV genotyping is not necessary. Anyone diagnosed with hepatitis C
who does not need specialist care can be treated with either:
- Epclusa® (sofosbuvir / velpatasvir) for 12 weeks;
- Maviret® (glecaprevir / pibrentasvir) for 8 weeks.
HCV RNA testing is recommended only at the time of diagnosis and
12 weeks after the completion of treatment to check for sustained virologic
A study published in
2014 estimated that approximately 74,000 people with chronic
hepatitis C infection were undiagnosed in 2014. In 2014, the French Viral
Hepatitis Testing Experts group recommended a one-time test for HIV,
hepatitis B and C for all men aged 18-60 and all pregnant women.