Journal List > Korean J Gastroenterol > v.67(3) > 1007480

Kim: Renewed 2015 Clinical Practice Guidelines for Management of Hepatitis C by Korean Association for the Study of the Liver; What Has Been Changed? – Indications for Treatment

Abstract

The landscape of treatment for HCV infection has evolved substantially with the advent of highly effective direct-acting antiviral agents (DAA). The Korean Association for the Study of the Liver updated guideline for managemnt of hepatitis C in accordance with the introduction of DAA into practice in late 2015. Due to high effectiveness and few side effects of DAA, indications for treatment has been widened to include patients who had been contraindicated for the combination treatment of peginterferon-α and ribavirin, i.e. decompensated cirrhosis and pre- and post-liver transplant setting. As succeesul treatment of HCV can reduce complications of cirrhosis, development of hepatocelluar carcinoma and liver-related mortality, and improve extrahepatic manifestions, all HCV-infected patients with no contraindication should be considered for treatment. Considering the risk for morbidity and mortality and benefit of treatment, patients with advanced fibrosis ≥ F3 including compensated and decompensated cirrhosis, those in the pre- and post-tranplasnt setting, and those with severe extrahepatic manifestations including HCV-related mixed cryoglobulinemia and glomerulonephritis should be given priority for treatment.

References

1. Tong MJ, el-Farra NS, Reikes AR, Co RL. Clinical outcomes after transfusion-associated hepatitis C. N Engl J Med. 1995; 332:1463–1466.
crossref
2. Thein HH, Yi Q, Dore GJ, Krahn MD. Estimation of stage-specific fibrosis progression rates in chronic hepatitis C virus infection: a metaanalysis and meta-regression. Hepatology. 2008; 48:418–431.
crossref
3. Poynard T, Bedossa P, Opolon P. Natural history of liver fibrosis progression in patients with chronic hepatitis C. The OBSVIRC, METAVIR, CLINIVIR, and DOSVIRC groups. Lancet. 1997; 349:825–832.
4. Lok AS, Seeff LB, Morgan TR, et al. HALT-C Trial Group. Incidence of hepatocellular carcinoma and associated risk factors in hepatitis C-related advanced liver disease. Gastroenterology. 2009; 136:138–148.
crossref
5. Sangiovanni A, Prati GM, Fasani P, et al. The natural history of compensated cirrhosis due to hepatitis C virus: A 17-year cohort study of 214 patients. Hepatology. 2006; 43:1303–1310.
crossref
6. Gomez EV, Rodriguez YS, Bertot LC, et al. The natural history of compensated HCV-related cirrhosis: a prospective long-term study. J Hepatol. 2013; 58:434–444.
crossref
7. Fattovich G, Giustina G, Degos F, et al. Morbidity and mortality in compensated cirrhosis type C: a retrospective follow-up study of 384 patients. Gastroenterology. 1997; 112:463–472.
crossref
8. Swain MG, Lai MY, Shiffman ML, et al. A sustained virologic response is durable in patients with chronic hepatitis C treated with peginterferon alfa-2a and ribavirin. Gastroenterology. 2010; 139:1593–1601.
crossref
9. Shiratori Y, Imazeki F, Moriyama M, et al. Histologic improvement of fibrosis in patients with hepatitis C who have sustained response to interferon therapy. Ann Intern Med. 2000; 132:517–524.
crossref
10. Poynard T, McHutchison J, Manns M, et al. Impact of pegylated interferon alfa-2b and ribavirin on liver fibrosis in patients with chronic hepatitis C. Gastroenterology. 2002; 122:1303–1313.
crossref
11. Pradat P, Tillmann HL, Sauleda S, et al. HENCORE Group. Longterm follow-up of the hepatitis C HENCORE cohort: response to therapy and occurrence of liver-related complications. J Viral Hepat. 2007; 14:556–563.
crossref
12. Shiratori Y, Ito Y, Yokosuka O, et al. Tokyo-Chiba Hepatitis Research Group. Antiviral therapy for cirrhotic hepatitis C: association with reduced hepatocellular carcinoma development and improved survival. Ann Intern Med. 2005; 142:105–114.
13. Ogawa E, Furusyo N, Kajiwara E, et al. Efficacy of pegylated interferon alpha-2b and ribavirin treatment on the risk of hepatocellular carcinoma in patients with chronic hepatitis C: a prospective, multicenter study. J Hepatol. 2013; 58:495–501.
crossref
14. Bruno S, Stroffolini T, Colombo M, et al. Sustained virological response to interferon-alpha is associated with improved outcome in HCV-related cirrhosis: a retrospective study. Hepatology. 2007; 45:579–587.
15. Fabrizi F, Dixit V, Messa P. Antiviral therapy of symptomatic HCV-associated mixed cryoglobulinemia: metaanalysis of clinical studies. J Med Virol. 2013; 85:1019–1027.
crossref
16. Feng B, Eknoyan G, Guo ZS, et al. Effect of interferon-alpha- based antiviral therapy on hepatitis C virus-associated glomerulonephritis: a metaanalysis. Nephrol Dial Transplant. 2012; 27:640–646.
17. Korean Association for the Study of the Liver (KASL). KASL clinical practice guidelines: management of hepatitis C. Clin Mol Hepatol. 2014; 20:89–136.
18. Everson GT, Hoefs JC, Seeff LB, et al. HALT-C Trial Group. Impact of disease severity on outcome of antiviral therapy for chronic hepatitis C: Lessons from the HALT-C trial. Hepatology. 2006; 44:1675–1684.
crossref
19. Di Bisceglie AM, Shiffman ML, Everson GT, et al. HALT-C Trial Investigators. Prolonged therapy of advanced chronic hepatitis C with low-dose peginterferon. N Engl J Med. 2008; 359:2429–2441.
crossref
20. Dienstag JL, Ghany MG, Morgan TR, et al. HALT-C Trial Group. A prospective study of the rate of progression in compensated, histologically advanced chronic hepatitis C. Hepatology. 2011; 54:396–405.
crossref
21. Neumann UP, Berg T, Bahra M, et al. Fibrosis progression after liver transplantation in patients with recurrent hepatitis C. J Hepatol. 2004; 41:830–836.
crossref
22. Charlton M, Seaberg E, Wiesner R, et al. Predictors of patient and graft survival following liver transplantation for hepatitis C. Hepatology. 1998; 28:823–830.
crossref
23. Forman LM, Lewis JD, Berlin JA, Feldman HI, Lucey MR. The association between hepatitis C infection and survival after orthotopic liver transplantation. Gastroenterology. 2002; 122:889–896.
crossref
24. Everson GT. Treatment of patients with hepatitis C virus on the waiting list. Liver Transpl. 2003; 9:S90–S94.
crossref
25. Forns X, Navasa M, Rodés J. Treatment of HCV infection in patients with advanced cirrhosis. Hepatology. 2004; 40:498.
crossref
26. Berenguer M, Palau A, Aguilera V, Rayón JM, Juan FS, Prieto M. Clinical benefits of antiviral therapy in patients with recurrent hepatitis C following liver transplantation. Am J Transplant. 2008; 8:679–687.
crossref
27. Picciotto FP, Tritto G, Lanza AG, et al. Sustained virological response to antiviral therapy reduces mortality in HCV reinfection after liver transplantation. J Hepatol. 2007; 46:459–465.
crossref
28. Curry MP, Forns X, Chung RT, et al. Sofosbuvir and ribavirin prevent recurrence of HCV infection after liver transplantation: an open-label study. Gastroenterology. 2015; 148:100–107.e1.
crossref
29. Charlton M, Everson GT, Flamm SL, et al. Ledipasvir and sofosbuvir plus ribavirin for treatment of hcv infection in patients with advanced liver disease. Gastroenterology. 2015; 149:649–659.
30. Pungpapong S, Aqel B, Leise M, et al. Multicenter experience using simeprevir and sofosbuvir with or without ribavirin to treat hepatitis C genotype 1 after liver transplant. Hepatology. 2015; 61:1880–1886.
crossref
31. Agnello V, Mecucci C, Casato M. Regression of splenic lymphoma after treatment of hepatitis C virus infection. N Engl J Med. 2002; 347:2168–2170. author reply 2168–2170.
crossref
32. Johnson RJ, Gretch DR, Yamabe H, et al. Membranoproliferative glomerulonephritis associated with hepatitis C virus infection. N Engl J Med. 1993; 328:465–470.
crossref
33. Johnson RJ, Gretch DR, Couser WG, et al. Hepatitis C virus-associated glomerulonephritis. Effect of alpha-interferon therapy. Kidney Int. 1994; 46:1700–1704.
34. Jezequel C, Bardou-Jacquet E, Desille Y, et al. Survival of patients infected by chronic hepatitis c and f0f1 fibrosis at baseline after a 15 years follow-up. J Hepatol. 2015; 62(Suppl 2):S589.
35. McCombs JS, Tonnu-MiHara I, Matsuda T, McGinnis J, Fox S. Can hepatitis C treatment be safely delayed? Evidence from the veterans administration healthcare system. J Hepatol. 2015; 62(Suppl 2):S191.
crossref
36. Øvrehus ALH, Blach S, Christensen PB, et al. Impact of prioritizing treatment in a high resource setting – minimizing the burden of HCV related disease in 15 years. J Hepatol. 2015; 62(Suppl 2):S591–S592.
37. Singal AK, Freeman DH Jr, Anand BS. Meta-analysis: interferon improves outcomes following ablation or resection of hepatocellular carcinoma. Aliment Pharmacol Ther. 2010; 32:851–858.
crossref
38. Breitenstein S, Dimitroulis D, Petrowsky H, Puhan MA, Müllhaupt B, Clavien PA. Systematic review and metaanalysis of interferon after curative treatment of hepatocellular carcinoma in patients with viral hepatitis. Br J Surg. 2009; 96:975–981.
crossref

Table 1.
Recommendations on Indications of Treatment in Patients with HCV Infection by Korean Association for the Study of the Liver
All HCV-infected patients with no contraindication to treatment should be considered for treatment (A1).
Patients with advanced fibrosis ≥ F3 (including compensated and decompensated cirrhosis) should be given priority for treatment (A1).
Treatment should be prioritized in the pre- and post-liver transplant setting (A1).
Treatment should be prioritized for patients with severe extrahepatic manifestations, including HCV-related mixed cryoglobulinemia and glomerulonephritis (A1).
Treatment should be individualized taking into consideration the severity of liver disease, probability of treatment success, risks of severe adverse effects, accompanying diseases, and patients' willingness to undergo treatment (B1).
HCV treatment is not recommended in patients with limited life expectancy due to extrahepatic diseases (B1).
TOOLS
Similar articles