Hepatitis C Guidance 2018 Update: AASLD-IDSA Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection

Chung, Raymond T.; Ghany, Marc G.; Kim, Arthur Y.; Marks, Kristen; Naggie, Susanna; Vargas, Hugo E.; Aronsohn, Andrew; Bhattacharya, Debika; Broder, Tina; Falade‐Nwulia, Oluwaseun; Fontana, Robert J.; Gordon, Stuart C.; Heller, Theo; Holmberg, Scott D.; Jhaveri, Ravi; Jonas, Maureen M.; Kiser, Jennifer J.; Linas, Benjamin P.; Re, Vincent Lo; Morgan, Timothy R.; Nahass, Ronald; Peters, Marion G.; Reddy, K. Rajender; Reynolds, Andrew; Scott, John D.; Searson, Gloria; Swan, Tracy; Terrault, Norah A.; Trooskin, Stacey; Wong, John B.; Workowski, Kimberly A.

doi:10.1093/cid/ciy585

Cited by 526 publications

(270 citation statements)

References 109 publications

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“…In a recently issued report by the United States Food and Drug Administration (FDA), rare but serious liver injuries or failures were seen in patients with advanced liver disease who had received PI‐containing DAA therapy including GLE/PIB (Mavyret) and ELB/GRA (Zepatier). In decompensated liver disease, PIs are contradicted and have been highlighted by practice guidelines . High efficacy and safety of DAA therapy have broadly increased its uptake in patients with cirrhosis and/or HCC.…”

Section: Discussionmentioning

confidence: 99%

Systematic review with meta‐analysis: effectiveness of direct‐acting antiviral treatment for hepatitis C in patients with hepatocellular carcinoma

Lockart

Alavi

et al. 2019

Aliment Pharmacol Ther

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Summary Background Direct‐acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection is highly curative and tolerable. Among patients with hepatocellular carcinoma (HCC), optimal timing of DAA therapy remains unclear. Data on efficacy of DAA therapy in patients with HCC would inform this decision‐making. Aim To evaluate response to DAA therapy among patients diagnosed with HCV infection and HCC. Methods Bibliographic databases and conference abstracts were searched. Meta‐analysis was conducted to pool sustained virologic response (SVR) estimates. Results Fifty‐six studies with 5522 patients with HCV and HCC were included. Overall SVR was 88.3% (95% CI 86.1‐90.4). Twenty‐seven studies included patients with prior or present HCC (n = 3126) and patients without HCC (n = 49 138), in which SVR was 88.2% (95% CI 85.0‐91.4) and 92.4% (95% CI 91.1‐93.7) among patients with and without HCC, respectively (odds ratio: 0.54, 95% CI 0.43‐0.68, P < .001). In the subgroup analyses, higher SVR was seen in patients who received curative HCC management (SVR 90.4%, 95% CI 88.3‐92.4), or treated with sofosbuvir + NS5A inhibitor DAAs (SVR 96.9%, 95% CI 94.3‐99.4), or in patients with HCV genotype 1 infection (SVR 92.0%, 95% CI 88.1‐95.6). Conclusion Response to DAA therapy was lower in patients with HCC compared to those without HCC, regardless of cirrhosis status. Among HCC patients, there was an impact of proportion with curative HCC management on DAA therapy response.

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Section: Discussionmentioning

confidence: 99%

Systematic review with meta‐analysis: effectiveness of direct‐acting antiviral treatment for hepatitis C in patients with hepatocellular carcinoma

Lockart

Alavi

et al. 2019

Aliment Pharmacol Ther

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“…During the era of interferon‐based therapy, treatment of HCV was limited in patients with cirrhosis due potential adverse events of therapy that were difficult to tolerate and often precipitated decompensation. The availability of DAAs with excellent safety profiles and higher efficacy now offer the prospect of treating this high‐risk patient group . Many studies revealed that viral clearance following DAAs has been associated with decline in liver stiffness and possible fibrosis regression; however, most of these studies were retrospective, including small number of patients and short follow‐up periods, and so definitive conclusion about the changes in hepatic fibrosis following DAAS therapy is not solid; also, most of these studies do not clearly differentiate between pre‐cirrhotic stage (F3) and established cirrhosis (F4).…”

Section: Introductionmentioning

confidence: 99%

Changes in hepatic fibrosis stages after achieving SVR following direct‐acting anti‐viral treatment: a prospective study

et al. 2020

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Summary Introduction Chronic hepatitis C (CHC) represents a major global health problem. The availability of direct‐acting anti‐virals (DAAs) allowed the treatment of many patients with liver cirrhosis (F4) and advanced hepatic fibrosis (F3). The impact of viral clearance following DAAs treatment on the natural history of liver cirrhosis is uncertain or not clearly evident in the literature as most studies were retrospective, including small number of patients and for short follow‐up duration; there is a need for a long follow‐up, large prospective study evaluating the changes in hepatic fibrosis after achieving sustained virological response (SVR) in cirrhotics. Patients and methods This is a prospective study including CHC patients with liver cirrhosis or advanced hepatic fibrosis who achieved SVR following DAAs from January 2015 until August 2017. Patients were followed up every 4‐6 months for at least 1 year from end of treatment. Staging of liver fibrosis was done using transient elastography and non‐invasive scores (FIB‐4, FIB‐5 and APRI). Results A total of 2326 CHC patients who achieved SVR were included. Follow‐up period was 23.51 ± 8.21 months (range 12‐45). In cirrhotic patients, 21.8% showed reversal of cirrhosis, 27.4% showed fibrosis regression while 50.8% remained stationary. About 26.5% of F3 patients showed reversal of fibrosis , 31.5% showed fibrosis regression and 30.6% remained stationary while 11.4% progressed to F4. Conclusion HCV clearance following DAAs treatment in CHC patients with liver cirrhosis or advanced hepatic fibrosis is associated with reversal of cirrhosis and regression of hepatic fibrosis in about 50% of patients.

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“…The sustained virologic response (SVR) rate in cirrhotic patients is also not satisfactory, which can be as low as 38% [7]. Recently, the discovery of direct acting antiviral agent (DAA) regimens overturns the obstacles encountered in Peg-IFN/RBV regimen, leading to nearly 100% SVR rate and applicable regardless of cirrhotic status [8,9]. However, a recent meta-analysis concluded that the HCC occurrence and recurrence rates were comparable between DAA-and IFN-treated patients regardless of the higher SVR rate of the DAA regimen [10].…”

Section: Introductionmentioning

confidence: 99%

Interferon Is Superior to Direct Acting Antiviral Therapy in Tertiary Prevention of Early Recurrence of Hepatocellular Carcinoma

Teng

Jeng

Yang

et al. 2019

Cancers

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The elimination of chronic hepatitis C infection (CHC) by pegylated interferon plus ribavirin (Peg-IFN/RBV) decreases hepatocellular carcinoma (HCC) recurrence rate. However, the tertiary prevention of HCC recurrence by direct acting antiviral agents (DAA) remains controversial. This study aims to compare the tertiary prevention effect between DAA and Peg-IFN/RBV in CHC-HCC patients. Three hundred and one patients who received curative HCC treatment were retrospectively recruited. The recurrence incidence rate (IR) was compared among patients either receiving Peg-IFN/RBV or DAA regimen or untreated by three timeframes (I: from HCC treatment to antiviral therapy; II: during antiviral therapy; III: after antiviral therapy). The prevention effect between Peg-IFN/RBV and DAA were compared in frame II and III after propensity score matching (PSM) with age, tumor staging, HCC treatment modality, and cirrhotic status. Before PSM, the recurrence IRs in three arms were comparable in frame I, while being lower in the Peg-IFN/RBV and DAA arm compared to the untreated arm in frame II. In frame III, the tertiary prevention effect lasted in the Peg-IFN/RBV arm (p < 0.001), but diminished in the DAA arm (p = 0.135) compared to untreated patients. After PSM, the HCC recurrence IR was higher in the DAA arm than the Peg-IFN/RBV arm in frame II (2724 vs. 666 per 10 4 person-years, log-rank p = 0.042) and III (5259 vs. 3278 per 10 4 person-years, log-rank p = 0.048). Preantiviral ALBI grade therapy is the only predictor for postantiviral therapy HCC recurrence. In conclusion, the tertiary prevention effect of HCC recurrence was not durable in DAA-treated patients, but persisted in Peg-IFN/RBV treatment patients.

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Hepatitis C Guidance 2018 Update: AASLD-IDSA Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection

Cited by 526 publications

References 109 publications

Systematic review with meta‐analysis: effectiveness of direct‐acting antiviral treatment for hepatitis C in patients with hepatocellular carcinoma

Systematic review with meta‐analysis: effectiveness of direct‐acting antiviral treatment for hepatitis C in patients with hepatocellular carcinoma

Changes in hepatic fibrosis stages after achieving SVR following direct‐acting anti‐viral treatment: a prospective study

Interferon Is Superior to Direct Acting Antiviral Therapy in Tertiary Prevention of Early Recurrence of Hepatocellular Carcinoma

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