CLDF Title
Home | Contact Us | Bookmark
HBV HE HCC HCV
About CLDF Centers of Educational Expertise  
CME Dinner Meetings Telewebs Webcasts Slide Library Abstract Library Conference Highlights
 
Back  
 
Reuters Health Information (2011-03-09): Hepatitis C guidelines focus on eradication of virus before liver damage occurs

Clinical

Hepatitis C guidelines focus on eradication of virus before liver damage occurs

Last Updated: 2011-03-09 12:59:05 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Clinical practice guidelines on the management of hepatitis C infection, issued by the European Association for the Study of the Liver, underscore the goal of detecting and treating the condition before it leads to complications.

The author of the guidelines, Dr. Antonio Crax� at the University of Palermo, Italy, notes that up to 210 million people worldwide may be affected by HCV infection, and it has become the leading cause of liver cancers in Europe.

As outlined in the Journal of Hepatology online February 28, the diagnosis of acute or chronic HCV infection is based on detection of anti-HCV antibodies. However, acute hepatitis C is usually silent, so early identification is less likely. Nonetheless, the guidelines advise, "Patients with acute hepatitis C should be considered for antiviral therapy in order to prevent progression to chronic hepatitis C."

The severity of liver disease should be determined before beginning therapy, according to the report. In particular, patients with cirrhosis have to be identified "as their prognosis and likelihood to respond to therapy are altered, and they require surveillance for HCC (hepatocellular carcinoma)".

Furthermore, HCV should be genotyped, since that also influences treatment.

Currently, the first-line "standard-of-care" treatment for chronic hepatitis C is based on the use of either of the two pegylated alpha interferons available, administered weekly subcutaneously, and daily oral ribavirin. "All treatment-naive patients with compensated chronic liver disease related to HCV who are willing to be treated and have no contraindication to pegylated interferon-alpha or ribavirin should be considered for therapy, whatever their baseline ALT level," according to the report.

Absolute contraindications to interferon-based treatment include uncontrolled depression, uncontrolled autoimmune diseases, pregnancy, and poorly controlled diabetes, among other conditions. Relative contraindications include hematologic abnormalities, significant CHD and untreated thyroid disease.

With treatment, a sustained viral response (SVR) with suppression to undetectable levels is achieved in 40%-54% of patients with HCV 1 and in 65%-82% of those with genotypes 2 or 3, Dr. Crax� notes.

The duration of treatment should be based on the virological response at weeks 4 and 12, and eventually week 24, the guidelines recommend. "The likelihood of SVR is directly proportional to the time of HCV RNA disappearance."

Up to 53% of patients who relapse respond to re-treatment with pegylated interferon-alpha and ribavirin.

The guidelines go on to address the management of HCV in patients coinfected with HIV or hepatitis B virus, patients on dialysis, and transplant patients.

Meanwhile, the author notes that progress is being made in the development of specific inhibitors and antiviral agents directly active against HCV, to be used in combination with interferon and ribavirin. "The present guidelines will be updated when these combinations are approved."

SOURCE: http://bit.ly/gYrTD6

J Hepatol 2011.

 
 
 
 
                 
 
HBV
Webcasts
Slide Library
Abstract Library
 
HE
CME Dinner Meeting
Webcasts
Slide Library
Abstract Library
 
HCC
Slide Library
Abstract Library
 
 
HCV
Webcasts
Slide Library
Abstract Library
 
CLDF Follow Us
   
 
About CLDF
Mission Statement
Board of Trustees
Board of Advisors
CLDF Supporters
 
Other Resources
Liver News Library
Journal Abstracts
Hep C Link to Care
 
Centers of
Educational Expertise
Regional Map
     
   
  The Chronic Liver Disease Foundation is a non-profit organization with content developed specifically for healthcare professionals.
© Copyright 2012-2014 Chronic Liver Disease Foundation. All rights reserved. This site is maintained as an educational resource for US healthcare providers only.
Use of this Web site is governed by the Chronic Liver Disease Foundation terms of use and privacy statement.