Kyung-Ah Kim

doi:10.4166/kjg.2016.67.3.123

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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

Review Article

Korean J Gastroenterol 2016;67(3):123-126.

Published online: 4 October 2016

DOI: https://doi.org/10.4166/kjg.2016.67.3.123

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

Kyung-Ah Kim

Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea

Correspondence to: Kyung-Ah Kim, Department of Internal Medicine, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang 10380, Korea. Tel: +82-31-910-7847, Fax: +82-31-910-7219, E-mail: kakim@ilsanpaik.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Hepatitis C, Direct acting antiviral agents, Indication, Therapeutics, Guideline

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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).

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