RECOMMENDATIONS FOR TESTING, MANAGING, AND TREATINGHOMETEST, EVALUATE, MONITORTREATMENT-NAIVETREATMENT-EXPERIENCEDUNIQUE & KEY POPULATIONS Table 1. Summary of the Process and Methods for the Guidance Development. Table 2. Rating System Used to Rate Level of Evidence and Strength of Recommendation. Table 3. Commonly Used Abbreviations and Their Expansions. References. Testing, Evaluation, and Monitoring of Hepatitis C - Browse Topics. Testing, Evaluation, and Monitoring of

Hepatitis C.

AASLD/IDSA HCV GUIDANCE PANEL. RECOMMENDATIONS FOR TESTING AASLD/IDSA HCV guidance panel. Recommendations for testing, managing, and treating hepatitis C. Updated August 27, 2020. . 2020

.

HCV IN CHILDREN

Although the prevalence of chronic hepatitis C is lower in children than adults, an estimated 3.5 to 5 million children worldwide have chronic HCV infection (Indolphi, 2019); (Gower, 2014).Data from the National Health and Nutrition Examination Survey (NHANES) indicate that 0.2% of 6- to 11-year-olds (31,000 children) and 0.4% of 12- to 19-year-olds (101,000 adolescents) in the US are HCV

HCV IN PREGNANCY

INITIAL TREATMENT OF ADULTS WITH HCV INFECTION SIMPLIFIED HCV TREATMENT* FOR TREATMENT-NAIVE ADULTS Patients in whom initial HCV treatment fails to achieve cure (SVR) should be evaluated for retreatment by a specialist, in accordance with AASLD/IDSA guidance. Until retreatment occurs, assessment for disease progression every 6 to 12 months with a hepatic function panel, CBC, and INR is recommended. HCV RESISTANCE PRIMER Introduction. Understanding principles of the emergence of drug-resistant viruses is critical when using targeted antiviral therapies. The best example of these principles can be gleaned from the study of HIV. Like HIV, HCV is an approximately 9.5 kilobase RNA virus that replicates very rapidly (billions of MONITORING PATIENTS WHO ARE STARTING HCV TREATMENT, ARE ON The recommended pretreatment testing assumes that a decision to treat with antiviral medications has already been made and that the testing involved in deciding to treat—including testing for HCV genotype and assessment of hepatic fibrosis—has already been completed (see When and in Whom to Initiate HCV Therapy).. Prior to starting treatment, patients should be evaluated for potential drug SIMPLIFIED HCV TREATMENT ALGORITHM FOR TREATMENT-NAIVE Calculate FIB-4 score.; Calculate CTP score: Patients with a CTP score ≥7 (ie, CTP B or C) have decompensated cirrhosis and this simplified treatment approach is not recommended.; Ultrasound of the liver (conducted within the prior 6 months): Evaluate to exclude HCC and subclinical ascites.; Medication reconciliation: Record current medications, including over-the-counter drugs and herbal TREATMENT-NAIVE GENOTYPE 3 Treatment-Naive Genotype 3. The following pages include guidance for management of treatment-naive patients with genotype 3 infection. Treatment-Naive Genotype 3 Without Cirrhosis. Treatment-Naive Genotype 3 With Compensated Cirrhosis. Simplified HCV Treatment for Treatment-Naive Adults Without Cirrhosis. Last update: August 27,

2020.

RECOMMENDATIONS FOR TESTING, MANAGING, AND TREATINGHOMETEST, EVALUATE, MONITORTREATMENT-NAIVETREATMENT-EXPERIENCEDUNIQUE & KEY POPULATIONS Table 1. Summary of the Process and Methods for the Guidance Development. Table 2. Rating System Used to Rate Level of Evidence and Strength of Recommendation. Table 3. Commonly Used Abbreviations and Their Expansions. References. Testing, Evaluation, and Monitoring of Hepatitis C - Browse Topics. Testing, Evaluation, and Monitoring of

Hepatitis C.

AASLD/IDSA HCV GUIDANCE PANEL. RECOMMENDATIONS FOR TESTING AASLD/IDSA HCV guidance panel. Recommendations for testing, managing, and treating hepatitis C. Updated August 27, 2020. . 2020

.

HCV IN CHILDREN

Although the prevalence of chronic hepatitis C is lower in children than adults, an estimated 3.5 to 5 million children worldwide have chronic HCV infection (Indolphi, 2019); (Gower, 2014).Data from the National Health and Nutrition Examination Survey (NHANES) indicate that 0.2% of 6- to 11-year-olds (31,000 children) and 0.4% of 12- to 19-year-olds (101,000 adolescents) in the US are HCV

HCV IN PREGNANCY

INITIAL TREATMENT OF ADULTS WITH HCV INFECTION SIMPLIFIED HCV TREATMENT* FOR TREATMENT-NAIVE ADULTS Patients in whom initial HCV treatment fails to achieve cure (SVR) should be evaluated for retreatment by a specialist, in accordance with AASLD/IDSA guidance. Until retreatment occurs, assessment for disease progression every 6 to 12 months with a hepatic function panel, CBC, and INR is recommended. HCV RESISTANCE PRIMER Introduction. Understanding principles of the emergence of drug-resistant viruses is critical when using targeted antiviral therapies. The best example of these principles can be gleaned from the study of HIV. Like HIV, HCV is an approximately 9.5 kilobase RNA virus that replicates very rapidly (billions of MONITORING PATIENTS WHO ARE STARTING HCV TREATMENT, ARE ON The recommended pretreatment testing assumes that a decision to treat with antiviral medications has already been made and that the testing involved in deciding to treat—including testing for HCV genotype and assessment of hepatic fibrosis—has already been completed (see When and in Whom to Initiate HCV Therapy).. Prior to starting treatment, patients should be evaluated for potential drug SIMPLIFIED HCV TREATMENT ALGORITHM FOR TREATMENT-NAIVE Calculate FIB-4 score.; Calculate CTP score: Patients with a CTP score ≥7 (ie, CTP B or C) have decompensated cirrhosis and this simplified treatment approach is not recommended.; Ultrasound of the liver (conducted within the prior 6 months): Evaluate to exclude HCC and subclinical ascites.; Medication reconciliation: Record current medications, including over-the-counter drugs and herbal TREATMENT-NAIVE GENOTYPE 3 Treatment-Naive Genotype 3. The following pages include guidance for management of treatment-naive patients with genotype 3 infection. Treatment-Naive Genotype 3 Without Cirrhosis. Treatment-Naive Genotype 3 With Compensated Cirrhosis. Simplified HCV Treatment for Treatment-Naive Adults Without Cirrhosis. Last update: August 27,

2020.

TESTING, EVALUATION, AND MONITORING OF HEPATITIS C The following pages address testing, evaluation, and monitoring of patients with HCV before, during and after antiviral therapy. HCV Testing and Linkage to Care. When and in Whom to Initiate HCV Therapy. Overview of Cost, Reimbursement, and Cost-Effectiveness Considerations

for Hepatitis C

MANAGEMENT OF ACUTE HCV INFECTION Diagnosis of acute HCV infection enables estimation of annual incidence rates and transmission patterns, thereby facilitating implementation and assessment of prevention programs. At the individual level, a diagnosis of acute infection expedites linkage to care, counseling regarding high-risk behavior, and timely interventions to reduce virus PATIENTS WITH HIV/HCV COINFECTION This section provides guidance on the treatment of chronic HCV infection in HIV/HCV-coinfected patients. For individuals with acute HCV infection, please refer to the Acute HCV section. HIV/HCV-coinfected patients suffer from more liver-related morbidity and mortality, nonhepatic organ dysfunction, and overall mortality than HCV-monoinfected patients (Lo Re, 2014); (). DHHS GUIDELINES FOR THE USE OF ANTIRETROVIRAL AGENTS IN DHHS Guidelines for the use of antiretroviral agents in adults and adolescents living with HIV. Updated July 9, 2020. Accessed July 9.

2020;.

TREATMENT-NAIVE GENOTYPE 1 Treatment-Naive Genotype 1. Four highly potent DAA combination regimens are recommended for patients with genotype 1 infection, although there are differences in the recommended regimens based on the HCV subtype, the presence or absence of baseline NS5A resistance-associated substitutions (RASs), and the presence or absence of compensated TREATMENT-NAIVE GENOTYPE 3 Treatment-Naive Genotype 3. The following pages include guidance for management of treatment-naive patients with genotype 3 infection. Treatment-Naive Genotype 3 Without Cirrhosis. Treatment-Naive Genotype 3 With Compensated Cirrhosis. Simplified HCV Treatment for Treatment-Naive Adults Without Cirrhosis. Last update: August 27,

2020.

TREATMENT OF HCV-UNINFECTED TRANSPLANT RECIPIENTS Recent data indicate increasing acceptance of organs from HCV-viremic donors among HCV-uninfected recipients (Cotter, 2019); (Potluri, 2019); (Bowring, 2018).Although no published data are available regarding the long-term (beyond 1 to 2 years) consequences to HCV-negative recipients transplanted with organs from HCV-viremic donors who are treated post-transplant with DAAs, limited short-term WHEN AND IN WHOM TO INITIATE HCV THERAPY When and in Whom to Initiate HCV Therapy. Successful hepatitis C treatment results in sustained virologic response (SVR), which is tantamount to virologic cure and, as such, is expected to benefit nearly all chronically infected persons. When the US Food and Drug Administration (FDA) approved the first interferon-sparing treatment

for HCV

HCV IN KEY POPULATIONS: MEN WHO HAVE SEX WITH MEN Incidence and Risk Factors for HCV Infection Among HIV-Infected Men Who Have Sex With Men Several outbreaks of sexually transmitted HCV infection among HIV-infected men who have sex with men (MSM) have been reported since 2000 (Wandeler, 2012); (van de Laar, 2010); (Urbanus, 2009); (Matthews, 2007).A recent systematic review reported an HCV incidence of 6.35/1000 person-years among HIV PATIENTS WITH DECOMPENSATED CIRRHOSIS Patients with HCV infection who have decompensated cirrhosis—moderate or severe hepatic impairment, ie, Child-Turcotte-Pugh (CTP) class B or class C—should be referred to a medical practitioner with expertise in that condition, ideally in a liver transplant center. I, C. Clinical trial data demonstrate that in the population of persons with RECOMMENDATIONS FOR TESTING, MANAGING, AND TREATINGHOMETEST, EVALUATE, MONITORTREATMENT-NAIVETREATMENT-EXPERIENCEDUNIQUE & KEY POPULATIONS Table 1. Summary of the Process and Methods for the Guidance Development. Table 2. Rating System Used to Rate Level of Evidence and Strength of Recommendation. Table 3. Commonly Used Abbreviations and Their Expansions. References. Testing, Evaluation, and Monitoring of Hepatitis C - Browse Topics. Testing, Evaluation, and Monitoring of

Hepatitis C.

AASLD/IDSA HCV GUIDANCE PANEL. RECOMMENDATIONS FOR TESTING AASLD/IDSA HCV guidance panel. Recommendations for testing, managing, and treating hepatitis C. Updated August 27, 2020. . 2020

.

HCV IN PREGNANCY

SIMPLIFIED HCV TREATMENT* FOR TREATMENT-NAIVE ADULTS Patients in whom initial HCV treatment fails to achieve cure (SVR) should be evaluated for retreatment by a specialist, in accordance with AASLD/IDSA guidance. Until retreatment occurs, assessment for disease progression every 6 to 12 months with a hepatic function panel, CBC, and INR is recommended. MANAGEMENT OF ACUTE HCV INFECTION Diagnosis of acute HCV infection enables estimation of annual incidence rates and transmission patterns, thereby facilitating implementation and assessment of prevention programs. At the individual level, a diagnosis of acute infection expedites linkage to care, counseling regarding high-risk behavior, and timely interventions to reduce virus HCV RESISTANCE PRIMER Introduction. Understanding principles of the emergence of drug-resistant viruses is critical when using targeted antiviral therapies. The best example of these principles can be gleaned from the study of HIV. Like HIV, HCV is an approximately 9.5 kilobase RNA virus that replicates very rapidly (billions of SIMPLIFIED HCV TREATMENT ALGORITHM FOR TREATMENT-NAIVE Calculate FIB-4 score.; Calculate CTP score: Patients with a CTP score ≥7 (ie, CTP B or C) have decompensated cirrhosis and this simplified treatment approach is not recommended.; Ultrasound of the liver (conducted within the prior 6 months): Evaluate to exclude HCC and subclinical ascites.; Medication reconciliation: Record current medications, including over-the-counter drugs and herbal MONITORING PATIENTS WHO ARE STARTING HCV TREATMENT, ARE ON The recommended pretreatment testing assumes that a decision to treat with antiviral medications has already been made and that the testing involved in deciding to treat—including testing for HCV genotype and assessment of hepatic fibrosis—has already been completed (see When and in Whom to Initiate HCV Therapy).. Prior to starting treatment, patients should be evaluated for potential drug CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC). TESTING Centers for Disease Control and Prevention (CDC). Testing for HCV infection: an update of guidance for clinicians and laboratorians.MMWR Morb Mortal Wkly Rep. 2013;62(18):362-365. TREATMENT WITH LEDIPASVIR-SOFOSBUVIR FOR 12 OR 24 WEEKS IN Colombo M, Aghemo A, Liu H, Zhang J, Dvory-Sobol H, Hyland R, et al. Treatment with ledipasvir-sofosbuvir for 12 or 24 weeks in kidney transplant recipients with chronic hepatitis C virus genotype 1 or 4 infection: a randomized trial. RECOMMENDATIONS FOR TESTING, MANAGING, AND TREATINGHOMETEST, EVALUATE, MONITORTREATMENT-NAIVETREATMENT-EXPERIENCEDUNIQUE & KEY POPULATIONS Table 1. Summary of the Process and Methods for the Guidance Development. Table 2. Rating System Used to Rate Level of Evidence and Strength of Recommendation. Table 3. Commonly Used Abbreviations and Their Expansions. References. Testing, Evaluation, and Monitoring of Hepatitis C - Browse Topics. Testing, Evaluation, and Monitoring of

Hepatitis C.

AASLD/IDSA HCV GUIDANCE PANEL. RECOMMENDATIONS FOR TESTING AASLD/IDSA HCV guidance panel. Recommendations for testing, managing, and treating hepatitis C. Updated August 27, 2020. . 2020

.

HCV IN PREGNANCY

SIMPLIFIED HCV TREATMENT* FOR TREATMENT-NAIVE ADULTS Patients in whom initial HCV treatment fails to achieve cure (SVR) should be evaluated for retreatment by a specialist, in accordance with AASLD/IDSA guidance. Until retreatment occurs, assessment for disease progression every 6 to 12 months with a hepatic function panel, CBC, and INR is recommended. MANAGEMENT OF ACUTE HCV INFECTION Diagnosis of acute HCV infection enables estimation of annual incidence rates and transmission patterns, thereby facilitating implementation and assessment of prevention programs. At the individual level, a diagnosis of acute infection expedites linkage to care, counseling regarding high-risk behavior, and timely interventions to reduce virus HCV RESISTANCE PRIMER Introduction. Understanding principles of the emergence of drug-resistant viruses is critical when using targeted antiviral therapies. The best example of these principles can be gleaned from the study of HIV. Like HIV, HCV is an approximately 9.5 kilobase RNA virus that replicates very rapidly (billions of SIMPLIFIED HCV TREATMENT ALGORITHM FOR TREATMENT-NAIVE Calculate FIB-4 score.; Calculate CTP score: Patients with a CTP score ≥7 (ie, CTP B or C) have decompensated cirrhosis and this simplified treatment approach is not recommended.; Ultrasound of the liver (conducted within the prior 6 months): Evaluate to exclude HCC and subclinical ascites.; Medication reconciliation: Record current medications, including over-the-counter drugs and herbal MONITORING PATIENTS WHO ARE STARTING HCV TREATMENT, ARE ON The recommended pretreatment testing assumes that a decision to treat with antiviral medications has already been made and that the testing involved in deciding to treat—including testing for HCV genotype and assessment of hepatic fibrosis—has already been completed (see When and in Whom to Initiate HCV Therapy).. Prior to starting treatment, patients should be evaluated for potential drug CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC). TESTING Centers for Disease Control and Prevention (CDC). Testing for HCV infection: an update of guidance for clinicians and laboratorians.MMWR Morb Mortal Wkly Rep. 2013;62(18):362-365. TREATMENT WITH LEDIPASVIR-SOFOSBUVIR FOR 12 OR 24 WEEKS IN Colombo M, Aghemo A, Liu H, Zhang J, Dvory-Sobol H, Hyland R, et al. Treatment with ledipasvir-sofosbuvir for 12 or 24 weeks in kidney transplant recipients with chronic hepatitis C virus genotype 1 or 4 infection: a randomized trial. TESTING, EVALUATION, AND MONITORING OF HEPATITIS C The following pages address testing, evaluation, and monitoring of patients with HCV before, during and after antiviral therapy. HCV Testing and Linkage to Care. When and in Whom to Initiate HCV Therapy. Overview of Cost, Reimbursement, and Cost-Effectiveness Considerations

for Hepatitis C

HCV IN CHILDREN

Although the prevalence of chronic hepatitis C is lower in children than adults, an estimated 3.5 to 5 million children worldwide have chronic HCV infection (Indolphi, 2019); (Gower, 2014).Data from the National Health and Nutrition Examination Survey (NHANES) indicate that 0.2% of 6- to 11-year-olds (31,000 children) and 0.4% of 12- to 19-year-olds (101,000 adolescents) in the US are HCV MANAGEMENT OF ACUTE HCV INFECTION Diagnosis of acute HCV infection enables estimation of annual incidence rates and transmission patterns, thereby facilitating implementation and assessment of prevention programs. At the individual level, a diagnosis of acute infection expedites linkage to care, counseling regarding high-risk behavior, and timely interventions to reduce virus INITIAL TREATMENT OF ADULTS WITH HCV INFECTION Initial treatment of HCV infection includes patients with chronic hepatitis C who have not been previously treated with interferon, peginterferon, ribavirin, or any HCV direct-acting antiviral (DAA) agent, whether investigational, or US Food and Drug Administration

(FDA) approved.

RECENT ANNOUNCEMENTS What’s New, Updates, and Changes to the Guidance. This version of the guidance has been updated to reflect new testing and management recommendations for pregnant women, people who inject drugs, men who have sex with men, and people who are incarcerated. The following new sections for management of patients with HCV in key populations have TREATMENT-NAIVE GENOTYPE 1 Treatment-Naive Genotype 1. Four highly potent DAA combination regimens are recommended for patients with genotype 1 infection, although there are differences in the recommended regimens based on the HCV subtype, the presence or absence of baseline NS5A resistance-associated substitutions (RASs), and the presence or absence of compensated SUMMARY: HCV IN PREGNANCY Recommendations for Monitoring HCV-Infected Women During Pregnancy; RECOMMENDED RATING : HCV RNA and routine liver function tests are recommended at initiation of prenatal care for HCV-antibody–positive pregnant women to assess the risk of mother-to-child transmission (MTCT) and severity of liver disease. CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC). TESTING Centers for Disease Control and Prevention (CDC). Testing for HCV infection: an update of guidance for clinicians and laboratorians.MMWR Morb Mortal Wkly Rep. 2013;62(18):362-365. KIDNEY TRANSPLANT PATIENTS Treatment-Naive and Non-DAA-Experienced Kidney Transplant Patients With Genotype 1-6 Infection, With or Without Compensated Cirrhosisa. a For decompensated cirrhosis, please refer to the appropriate section. b Dosing is 3 coformulated tablets (glecaprevir /pibrentasvir

) taken once daily.

RESISTANCE ANALYSIS IN PATIENTS WITH GENOTYPE 1-6 HCV Hezode C, Reau N, Svarovskaia ES, Doehle BP, Shanmugam R, Dvory-Sobol H, et al. Resistance analysis in patients with genotype 1-6 HCV infection treated with sofosbuvir/velpatasvir in the phase III

studies.

RECOMMENDATIONS FOR TESTING, MANAGING, AND TREATINGHOMETEST, EVALUATE, MONITORTREATMENT-NAIVETREATMENT-EXPERIENCEDUNIQUE & KEY POPULATIONS Table 1. Summary of the Process and Methods for the Guidance Development. Table 2. Rating System Used to Rate Level of Evidence and Strength of Recommendation. Table 3. Commonly Used Abbreviations and Their Expansions. References. Testing, Evaluation, and Monitoring of Hepatitis C - Browse Topics. Testing, Evaluation, and Monitoring of

Hepatitis C.

AASLD/IDSA HCV GUIDANCE PANEL. RECOMMENDATIONS FOR TESTING AASLD/IDSA HCV guidance panel. Recommendations for testing, managing, and treating hepatitis C. Updated August 27, 2020. . 2020

.

HCV IN PREGNANCY

SIMPLIFIED HCV TREATMENT* FOR TREATMENT-NAIVE ADULTS Patients in whom initial HCV treatment fails to achieve cure (SVR) should be evaluated for retreatment by a specialist, in accordance with AASLD/IDSA guidance. Until retreatment occurs, assessment for disease progression every 6 to 12 months with a hepatic function panel, CBC, and INR is recommended. MANAGEMENT OF ACUTE HCV INFECTION Diagnosis of acute HCV infection enables estimation of annual incidence rates and transmission patterns, thereby facilitating implementation and assessment of prevention programs. At the individual level, a diagnosis of acute infection expedites linkage to care, counseling regarding high-risk behavior, and timely interventions to reduce virus HCV RESISTANCE PRIMER Introduction. Understanding principles of the emergence of drug-resistant viruses is critical when using targeted antiviral therapies. The best example of these principles can be gleaned from the study of HIV. Like HIV, HCV is an approximately 9.5 kilobase RNA virus that replicates very rapidly (billions of SIMPLIFIED HCV TREATMENT ALGORITHM FOR TREATMENT-NAIVE Calculate FIB-4 score.; Calculate CTP score: Patients with a CTP score ≥7 (ie, CTP B or C) have decompensated cirrhosis and this simplified treatment approach is not recommended.; Ultrasound of the liver (conducted within the prior 6 months): Evaluate to exclude HCC and subclinical ascites.; Medication reconciliation: Record current medications, including over-the-counter drugs and herbal MONITORING PATIENTS WHO ARE STARTING HCV TREATMENT, ARE ON The recommended pretreatment testing assumes that a decision to treat with antiviral medications has already been made and that the testing involved in deciding to treat—including testing for HCV genotype and assessment of hepatic fibrosis—has already been completed (see When and in Whom to Initiate HCV Therapy).. Prior to starting treatment, patients should be evaluated for potential drug CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC). TESTING Centers for Disease Control and Prevention (CDC). Testing for HCV infection: an update of guidance for clinicians and laboratorians.MMWR Morb Mortal Wkly Rep. 2013;62(18):362-365. TREATMENT WITH LEDIPASVIR-SOFOSBUVIR FOR 12 OR 24 WEEKS IN Colombo M, Aghemo A, Liu H, Zhang J, Dvory-Sobol H, Hyland R, et al. Treatment with ledipasvir-sofosbuvir for 12 or 24 weeks in kidney transplant recipients with chronic hepatitis C virus genotype 1 or 4 infection: a randomized trial. RECOMMENDATIONS FOR TESTING, MANAGING, AND TREATINGHOMETEST, EVALUATE, MONITORTREATMENT-NAIVETREATMENT-EXPERIENCEDUNIQUE & KEY POPULATIONS Table 1. Summary of the Process and Methods for the Guidance Development. Table 2. Rating System Used to Rate Level of Evidence and Strength of Recommendation. Table 3. Commonly Used Abbreviations and Their Expansions. References. Testing, Evaluation, and Monitoring of Hepatitis C - Browse Topics. Testing, Evaluation, and Monitoring of

Hepatitis C.

AASLD/IDSA HCV GUIDANCE PANEL. RECOMMENDATIONS FOR TESTING AASLD/IDSA HCV guidance panel. Recommendations for testing, managing, and treating hepatitis C. Updated August 27, 2020. . 2020

.

HCV IN PREGNANCY

SIMPLIFIED HCV TREATMENT* FOR TREATMENT-NAIVE ADULTS Patients in whom initial HCV treatment fails to achieve cure (SVR) should be evaluated for retreatment by a specialist, in accordance with AASLD/IDSA guidance. Until retreatment occurs, assessment for disease progression every 6 to 12 months with a hepatic function panel, CBC, and INR is recommended. MANAGEMENT OF ACUTE HCV INFECTION Diagnosis of acute HCV infection enables estimation of annual incidence rates and transmission patterns, thereby facilitating implementation and assessment of prevention programs. At the individual level, a diagnosis of acute infection expedites linkage to care, counseling regarding high-risk behavior, and timely interventions to reduce virus HCV RESISTANCE PRIMER Introduction. Understanding principles of the emergence of drug-resistant viruses is critical when using targeted antiviral therapies. The best example of these principles can be gleaned from the study of HIV. Like HIV, HCV is an approximately 9.5 kilobase RNA virus that replicates very rapidly (billions of SIMPLIFIED HCV TREATMENT ALGORITHM FOR TREATMENT-NAIVE Calculate FIB-4 score.; Calculate CTP score: Patients with a CTP score ≥7 (ie, CTP B or C) have decompensated cirrhosis and this simplified treatment approach is not recommended.; Ultrasound of the liver (conducted within the prior 6 months): Evaluate to exclude HCC and subclinical ascites.; Medication reconciliation: Record current medications, including over-the-counter drugs and herbal MONITORING PATIENTS WHO ARE STARTING HCV TREATMENT, ARE ON The recommended pretreatment testing assumes that a decision to treat with antiviral medications has already been made and that the testing involved in deciding to treat—including testing for HCV genotype and assessment of hepatic fibrosis—has already been completed (see When and in Whom to Initiate HCV Therapy).. Prior to starting treatment, patients should be evaluated for potential drug CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC). TESTING Centers for Disease Control and Prevention (CDC). Testing for HCV infection: an update of guidance for clinicians and laboratorians.MMWR Morb Mortal Wkly Rep. 2013;62(18):362-365. TREATMENT WITH LEDIPASVIR-SOFOSBUVIR FOR 12 OR 24 WEEKS IN Colombo M, Aghemo A, Liu H, Zhang J, Dvory-Sobol H, Hyland R, et al. Treatment with ledipasvir-sofosbuvir for 12 or 24 weeks in kidney transplant recipients with chronic hepatitis C virus genotype 1 or 4 infection: a randomized trial. TESTING, EVALUATION, AND MONITORING OF HEPATITIS C The following pages address testing, evaluation, and monitoring of patients with HCV before, during and after antiviral therapy. HCV Testing and Linkage to Care. When and in Whom to Initiate HCV Therapy. Overview of Cost, Reimbursement, and Cost-Effectiveness Considerations

for Hepatitis C

HCV IN CHILDREN

Although the prevalence of chronic hepatitis C is lower in children than adults, an estimated 3.5 to 5 million children worldwide have chronic HCV infection (Indolphi, 2019); (Gower, 2014).Data from the National Health and Nutrition Examination Survey (NHANES) indicate that 0.2% of 6- to 11-year-olds (31,000 children) and 0.4% of 12- to 19-year-olds (101,000 adolescents) in the US are HCV MANAGEMENT OF ACUTE HCV INFECTION Diagnosis of acute HCV infection enables estimation of annual incidence rates and transmission patterns, thereby facilitating implementation and assessment of prevention programs. At the individual level, a diagnosis of acute infection expedites linkage to care, counseling regarding high-risk behavior, and timely interventions to reduce virus INITIAL TREATMENT OF ADULTS WITH HCV INFECTION Initial treatment of HCV infection includes patients with chronic hepatitis C who have not been previously treated with interferon, peginterferon, ribavirin, or any HCV direct-acting antiviral (DAA) agent, whether investigational, or US Food and Drug Administration

(FDA) approved.

RECENT ANNOUNCEMENTS What’s New, Updates, and Changes to the Guidance. This version of the guidance has been updated to reflect new testing and management recommendations for pregnant women, people who inject drugs, men who have sex with men, and people who are incarcerated. The following new sections for management of patients with HCV in key populations have TREATMENT-NAIVE GENOTYPE 1 Treatment-Naive Genotype 1. Four highly potent DAA combination regimens are recommended for patients with genotype 1 infection, although there are differences in the recommended regimens based on the HCV subtype, the presence or absence of baseline NS5A resistance-associated substitutions (RASs), and the presence or absence of compensated SUMMARY: HCV IN PREGNANCY Recommendations for Monitoring HCV-Infected Women During Pregnancy; RECOMMENDED RATING : HCV RNA and routine liver function tests are recommended at initiation of prenatal care for HCV-antibody–positive pregnant women to assess the risk of mother-to-child transmission (MTCT) and severity of liver disease. CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC). TESTING Centers for Disease Control and Prevention (CDC). Testing for HCV infection: an update of guidance for clinicians and laboratorians.MMWR Morb Mortal Wkly Rep. 2013;62(18):362-365. KIDNEY TRANSPLANT PATIENTS Treatment-Naive and Non-DAA-Experienced Kidney Transplant Patients With Genotype 1-6 Infection, With or Without Compensated Cirrhosisa. a For decompensated cirrhosis, please refer to the appropriate section. b Dosing is 3 coformulated tablets (glecaprevir /pibrentasvir

) taken once daily.

RESISTANCE ANALYSIS IN PATIENTS WITH GENOTYPE 1-6 HCV Hezode C, Reau N, Svarovskaia ES, Doehle BP, Shanmugam R, Dvory-Sobol H, et al. Resistance analysis in patients with genotype 1-6 HCV infection treated with sofosbuvir/velpatasvir in the phase III

studies.

RECOMMENDATIONS FOR TESTING, MANAGING, AND TREATINGHOMETEST, EVALUATE, MONITORTREATMENT-NAIVETREATMENT-EXPERIENCEDUNIQUE & KEY POPULATIONS Table 1. Summary of the Process and Methods for the Guidance Development. Table 2. Rating System Used to Rate Level of Evidence and Strength of Recommendation. Table 3. Commonly Used Abbreviations and Their Expansions. References. Testing, Evaluation, and Monitoring of Hepatitis C - Browse Topics. Testing, Evaluation, and Monitoring of

Hepatitis C.

HCV IN PREGNANCY

TESTING, EVALUATION, AND MONITORING OF HEPATITIS C The following pages address testing, evaluation, and monitoring of patients with HCV before, during and after antiviral therapy. HCV Testing and Linkage to Care. When and in Whom to Initiate HCV Therapy. Overview of Cost, Reimbursement, and Cost-Effectiveness Considerations

for Hepatitis C

HCV IN CHILDREN

Although the prevalence of chronic hepatitis C is lower in children than adults, an estimated 3.5 to 5 million children worldwide have chronic HCV infection (Indolphi, 2019); (Gower, 2014).Data from the National Health and Nutrition Examination Survey (NHANES) indicate that 0.2% of 6- to 11-year-olds (31,000 children) and 0.4% of 12- to 19-year-olds (101,000 adolescents) in the US are HCV INITIAL TREATMENT OF ADULTS WITH HCV INFECTION SIMPLIFIED HCV TREATMENT* FOR TREATMENT-NAIVE ADULTS Patients in whom initial HCV treatment fails to achieve cure (SVR) should be evaluated for retreatment by a specialist, in accordance with AASLD/IDSA guidance. Until retreatment occurs, assessment for disease progression every 6 to 12 months with a hepatic function panel, CBC, and INR is recommended. HCV RESISTANCE PRIMER Introduction. Understanding principles of the emergence of drug-resistant viruses is critical when using targeted antiviral therapies. The best example of these principles can be gleaned from the study of HIV. Like HIV, HCV is an approximately 9.5 kilobase RNA virus that replicates very rapidly (billions of SIMPLIFIED HCV TREATMENT ALGORITHM FOR TREATMENT-NAIVE Calculate FIB-4 score.; Calculate CTP score: Patients with a CTP score ≥7 (ie, CTP B or C) have decompensated cirrhosis and this simplified treatment approach is not recommended.; Ultrasound of the liver (conducted within the prior 6 months): Evaluate to exclude HCC and subclinical ascites.; Medication reconciliation: Record current medications, including over-the-counter drugs and herbal MONITORING PATIENTS WHO ARE STARTING HCV TREATMENT, ARE ON The recommended pretreatment testing assumes that a decision to treat with antiviral medications has already been made and that the testing involved in deciding to treat—including testing for HCV genotype and assessment of hepatic fibrosis—has already been completed (see When and in Whom to Initiate HCV Therapy).. Prior to starting treatment, patients should be evaluated for potential drug TREATMENT-NAIVE GENOTYPE 1 Treatment-Naive Genotype 1. Four highly potent DAA combination regimens are recommended for patients with genotype 1 infection, although there are differences in the recommended regimens based on the HCV subtype, the presence or absence of baseline NS5A resistance-associated substitutions (RASs), and the presence or absence of compensated RECOMMENDATIONS FOR TESTING, MANAGING, AND TREATINGHOMETEST, EVALUATE, MONITORTREATMENT-NAIVETREATMENT-EXPERIENCEDUNIQUE & KEY POPULATIONS Table 1. Summary of the Process and Methods for the Guidance Development. Table 2. Rating System Used to Rate Level of Evidence and Strength of Recommendation. Table 3. Commonly Used Abbreviations and Their Expansions. References. Testing, Evaluation, and Monitoring of Hepatitis C - Browse Topics. Testing, Evaluation, and Monitoring of

Hepatitis C.

HCV IN PREGNANCY

TESTING, EVALUATION, AND MONITORING OF HEPATITIS C The following pages address testing, evaluation, and monitoring of patients with HCV before, during and after antiviral therapy. HCV Testing and Linkage to Care. When and in Whom to Initiate HCV Therapy. Overview of Cost, Reimbursement, and Cost-Effectiveness Considerations

for Hepatitis C

HCV IN CHILDREN

Although the prevalence of chronic hepatitis C is lower in children than adults, an estimated 3.5 to 5 million children worldwide have chronic HCV infection (Indolphi, 2019); (Gower, 2014).Data from the National Health and Nutrition Examination Survey (NHANES) indicate that 0.2% of 6- to 11-year-olds (31,000 children) and 0.4% of 12- to 19-year-olds (101,000 adolescents) in the US are HCV INITIAL TREATMENT OF ADULTS WITH HCV INFECTION SIMPLIFIED HCV TREATMENT* FOR TREATMENT-NAIVE ADULTS Patients in whom initial HCV treatment fails to achieve cure (SVR) should be evaluated for retreatment by a specialist, in accordance with AASLD/IDSA guidance. Until retreatment occurs, assessment for disease progression every 6 to 12 months with a hepatic function panel, CBC, and INR is recommended. HCV RESISTANCE PRIMER Introduction. Understanding principles of the emergence of drug-resistant viruses is critical when using targeted antiviral therapies. The best example of these principles can be gleaned from the study of HIV. Like HIV, HCV is an approximately 9.5 kilobase RNA virus that replicates very rapidly (billions of SIMPLIFIED HCV TREATMENT ALGORITHM FOR TREATMENT-NAIVE Calculate FIB-4 score.; Calculate CTP score: Patients with a CTP score ≥7 (ie, CTP B or C) have decompensated cirrhosis and this simplified treatment approach is not recommended.; Ultrasound of the liver (conducted within the prior 6 months): Evaluate to exclude HCC and subclinical ascites.; Medication reconciliation: Record current medications, including over-the-counter drugs and herbal MONITORING PATIENTS WHO ARE STARTING HCV TREATMENT, ARE ON The recommended pretreatment testing assumes that a decision to treat with antiviral medications has already been made and that the testing involved in deciding to treat—including testing for HCV genotype and assessment of hepatic fibrosis—has already been completed (see When and in Whom to Initiate HCV Therapy).. Prior to starting treatment, patients should be evaluated for potential drug TREATMENT-NAIVE GENOTYPE 1 Treatment-Naive Genotype 1. Four highly potent DAA combination regimens are recommended for patients with genotype 1 infection, although there are differences in the recommended regimens based on the HCV subtype, the presence or absence of baseline NS5A resistance-associated substitutions (RASs), and the presence or absence of compensated TESTING, EVALUATION, AND MONITORING OF HEPATITIS C The following pages address testing, evaluation, and monitoring of patients with HCV before, during and after antiviral therapy. HCV Testing and Linkage to Care. When and in Whom to Initiate HCV Therapy. Overview of Cost, Reimbursement, and Cost-Effectiveness Considerations

for Hepatitis C

HCV IN CHILDREN

Although the prevalence of chronic hepatitis C is lower in children than adults, an estimated 3.5 to 5 million children worldwide have chronic HCV infection (Indolphi, 2019); (Gower, 2014).Data from the National Health and Nutrition Examination Survey (NHANES) indicate that 0.2% of 6- to 11-year-olds (31,000 children) and 0.4% of 12- to 19-year-olds (101,000 adolescents) in the US are HCV AASLD/IDSA HCV GUIDANCE PANEL. RECOMMENDATIONS FOR TESTING AASLD/IDSA HCV guidance panel. Recommendations for testing, managing, and treating hepatitis C. Updated August 27, 2020. . 2020

.

PATIENTS WITH HIV/HCV COINFECTION This section provides guidance on the treatment of chronic HCV infection in HIV/HCV-coinfected patients. For individuals with acute HCV infection, please refer to the Acute HCV section. HIV/HCV-coinfected patients suffer from more liver-related morbidity and mortality, nonhepatic organ dysfunction, and overall mortality than HCV-monoinfected patients (Lo Re, 2014); (). SUMMARY: HCV IN PREGNANCY Recommendations for Monitoring HCV-Infected Women During Pregnancy; RECOMMENDED RATING : HCV RNA and routine liver function tests are recommended at initiation of prenatal care for HCV-antibody–positive pregnant women to assess the risk of mother-to-child transmission (MTCT) and severity of liver disease. TREATMENT OF HCV-UNINFECTED TRANSPLANT RECIPIENTS Recent data indicate increasing acceptance of organs from HCV-viremic donors among HCV-uninfected recipients (Cotter, 2019); (Potluri, 2019); (Bowring, 2018).Although no published data are available regarding the long-term (beyond 1 to 2 years) consequences to HCV-negative recipients transplanted with organs from HCV-viremic donors who are treated post-transplant with DAAs, limited short-term PATIENTS WITH DECOMPENSATED CIRRHOSIS Patients with HCV infection who have decompensated cirrhosis—moderate or severe hepatic impairment, ie, Child-Turcotte-Pugh (CTP) class B or class C—should be referred to a medical practitioner with expertise in that condition, ideally in a liver transplant center. I, C. Clinical trial data demonstrate that in the population of persons with WHEN AND IN WHOM TO INITIATE HCV THERAPY When and in Whom to Initiate HCV Therapy. Successful hepatitis C treatment results in sustained virologic response (SVR), which is tantamount to virologic cure and, as such, is expected to benefit nearly all chronically infected persons. When the US Food and Drug Administration (FDA) approved the first interferon-sparing treatment

for HCV

CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC Centers for Disease Control and Prevention (CDC). Recommendations for preventing transmission of infections among chronic hemodialysis

patients.

IMPLEMENTATION AND PRELIMINARY RESULTS OF AN EMERGENCY Schechter-Perkins EM, Miller NS, Hall J, et al. Implementation and preliminary results of an emergency department nontargeted, opt-out hepatitis C virus screening program. RECOMMENDATIONS FOR TESTING, MANAGING, AND TREATINGHOMETEST, EVALUATE, MONITORTREATMENT-NAIVETREATMENT-EXPERIENCEDUNIQUE & KEY POPULATIONS Table 1. Summary of the Process and Methods for the Guidance Development. Table 2. Rating System Used to Rate Level of Evidence and Strength of Recommendation. Table 3. Commonly Used Abbreviations and Their Expansions. References. Testing, Evaluation, and Monitoring of Hepatitis C - Browse Topics. Testing, Evaluation, and Monitoring of

Hepatitis C.

HCV IN PREGNANCY

TESTING, EVALUATION, AND MONITORING OF HEPATITIS C The following pages address testing, evaluation, and monitoring of patients with HCV before, during and after antiviral therapy. HCV Testing and Linkage to Care. When and in Whom to Initiate HCV Therapy. Overview of Cost, Reimbursement, and Cost-Effectiveness Considerations

for Hepatitis C

HCV IN CHILDREN

Although the prevalence of chronic hepatitis C is lower in children than adults, an estimated 3.5 to 5 million children worldwide have chronic HCV infection (Indolphi, 2019); (Gower, 2014).Data from the National Health and Nutrition Examination Survey (NHANES) indicate that 0.2% of 6- to 11-year-olds (31,000 children) and 0.4% of 12- to 19-year-olds (101,000 adolescents) in the US are HCV INITIAL TREATMENT OF ADULTS WITH HCV INFECTION SIMPLIFIED HCV TREATMENT* FOR TREATMENT-NAIVE ADULTS Patients in whom initial HCV treatment fails to achieve cure (SVR) should be evaluated for retreatment by a specialist, in accordance with AASLD/IDSA guidance. Until retreatment occurs, assessment for disease progression every 6 to 12 months with a hepatic function panel, CBC, and INR is recommended. HCV RESISTANCE PRIMER Introduction. Understanding principles of the emergence of drug-resistant viruses is critical when using targeted antiviral therapies. The best example of these principles can be gleaned from the study of HIV. Like HIV, HCV is an approximately 9.5 kilobase RNA virus that replicates very rapidly (billions of SIMPLIFIED HCV TREATMENT ALGORITHM FOR TREATMENT-NAIVE Calculate FIB-4 score.; Calculate CTP score: Patients with a CTP score ≥7 (ie, CTP B or C) have decompensated cirrhosis and this simplified treatment approach is not recommended.; Ultrasound of the liver (conducted within the prior 6 months): Evaluate to exclude HCC and subclinical ascites.; Medication reconciliation: Record current medications, including over-the-counter drugs and herbal MONITORING PATIENTS WHO ARE STARTING HCV TREATMENT, ARE ON The recommended pretreatment testing assumes that a decision to treat with antiviral medications has already been made and that the testing involved in deciding to treat—including testing for HCV genotype and assessment of hepatic fibrosis—has already been completed (see When and in Whom to Initiate HCV Therapy).. Prior to starting treatment, patients should be evaluated for potential drug TREATMENT-NAIVE GENOTYPE 1 Treatment-Naive Genotype 1. Four highly potent DAA combination regimens are recommended for patients with genotype 1 infection, although there are differences in the recommended regimens based on the HCV subtype, the presence or absence of baseline NS5A resistance-associated substitutions (RASs), and the presence or absence of compensated RECOMMENDATIONS FOR TESTING, MANAGING, AND TREATINGHOMETEST, EVALUATE, MONITORTREATMENT-NAIVETREATMENT-EXPERIENCEDUNIQUE & KEY POPULATIONS Table 1. Summary of the Process and Methods for the Guidance Development. Table 2. Rating System Used to Rate Level of Evidence and Strength of Recommendation. Table 3. Commonly Used Abbreviations and Their Expansions. References. Testing, Evaluation, and Monitoring of Hepatitis C - Browse Topics. Testing, Evaluation, and Monitoring of

Hepatitis C.

HCV IN PREGNANCY

TESTING, EVALUATION, AND MONITORING OF HEPATITIS C The following pages address testing, evaluation, and monitoring of patients with HCV before, during and after antiviral therapy. HCV Testing and Linkage to Care. When and in Whom to Initiate HCV Therapy. Overview of Cost, Reimbursement, and Cost-Effectiveness Considerations

for Hepatitis C

HCV IN CHILDREN

Although the prevalence of chronic hepatitis C is lower in children than adults, an estimated 3.5 to 5 million children worldwide have chronic HCV infection (Indolphi, 2019); (Gower, 2014).Data from the National Health and Nutrition Examination Survey (NHANES) indicate that 0.2% of 6- to 11-year-olds (31,000 children) and 0.4% of 12- to 19-year-olds (101,000 adolescents) in the US are HCV INITIAL TREATMENT OF ADULTS WITH HCV INFECTION SIMPLIFIED HCV TREATMENT* FOR TREATMENT-NAIVE ADULTS Patients in whom initial HCV treatment fails to achieve cure (SVR) should be evaluated for retreatment by a specialist, in accordance with AASLD/IDSA guidance. Until retreatment occurs, assessment for disease progression every 6 to 12 months with a hepatic function panel, CBC, and INR is recommended. HCV RESISTANCE PRIMER Introduction. Understanding principles of the emergence of drug-resistant viruses is critical when using targeted antiviral therapies. The best example of these principles can be gleaned from the study of HIV. Like HIV, HCV is an approximately 9.5 kilobase RNA virus that replicates very rapidly (billions of SIMPLIFIED HCV TREATMENT ALGORITHM FOR TREATMENT-NAIVE Calculate FIB-4 score.; Calculate CTP score: Patients with a CTP score ≥7 (ie, CTP B or C) have decompensated cirrhosis and this simplified treatment approach is not recommended.; Ultrasound of the liver (conducted within the prior 6 months): Evaluate to exclude HCC and subclinical ascites.; Medication reconciliation: Record current medications, including over-the-counter drugs and herbal MONITORING PATIENTS WHO ARE STARTING HCV TREATMENT, ARE ON The recommended pretreatment testing assumes that a decision to treat with antiviral medications has already been made and that the testing involved in deciding to treat—including testing for HCV genotype and assessment of hepatic fibrosis—has already been completed (see When and in Whom to Initiate HCV Therapy).. Prior to starting treatment, patients should be evaluated for potential drug TREATMENT-NAIVE GENOTYPE 1 Treatment-Naive Genotype 1. Four highly potent DAA combination regimens are recommended for patients with genotype 1 infection, although there are differences in the recommended regimens based on the HCV subtype, the presence or absence of baseline NS5A resistance-associated substitutions (RASs), and the presence or absence of compensated TESTING, EVALUATION, AND MONITORING OF HEPATITIS C The following pages address testing, evaluation, and monitoring of patients with HCV before, during and after antiviral therapy. HCV Testing and Linkage to Care. When and in Whom to Initiate HCV Therapy. Overview of Cost, Reimbursement, and Cost-Effectiveness Considerations

for Hepatitis C

HCV IN CHILDREN

Although the prevalence of chronic hepatitis C is lower in children than adults, an estimated 3.5 to 5 million children worldwide have chronic HCV infection (Indolphi, 2019); (Gower, 2014).Data from the National Health and Nutrition Examination Survey (NHANES) indicate that 0.2% of 6- to 11-year-olds (31,000 children) and 0.4% of 12- to 19-year-olds (101,000 adolescents) in the US are HCV AASLD/IDSA HCV GUIDANCE PANEL. RECOMMENDATIONS FOR TESTING AASLD/IDSA HCV guidance panel. Recommendations for testing, managing, and treating hepatitis C. Updated August 27, 2020. . 2020

.

PATIENTS WITH HIV/HCV COINFECTION This section provides guidance on the treatment of chronic HCV infection in HIV/HCV-coinfected patients. For individuals with acute HCV infection, please refer to the Acute HCV section. HIV/HCV-coinfected patients suffer from more liver-related morbidity and mortality, nonhepatic organ dysfunction, and overall mortality than HCV-monoinfected patients (Lo Re, 2014); (). SUMMARY: HCV IN PREGNANCY Recommendations for Monitoring HCV-Infected Women During Pregnancy; RECOMMENDED RATING : HCV RNA and routine liver function tests are recommended at initiation of prenatal care for HCV-antibody–positive pregnant women to assess the risk of mother-to-child transmission (MTCT) and severity of liver disease. TREATMENT OF HCV-UNINFECTED TRANSPLANT RECIPIENTS Recent data indicate increasing acceptance of organs from HCV-viremic donors among HCV-uninfected recipients (Cotter, 2019); (Potluri, 2019); (Bowring, 2018).Although no published data are available regarding the long-term (beyond 1 to 2 years) consequences to HCV-negative recipients transplanted with organs from HCV-viremic donors who are treated post-transplant with DAAs, limited short-term PATIENTS WITH DECOMPENSATED CIRRHOSIS Patients with HCV infection who have decompensated cirrhosis—moderate or severe hepatic impairment, ie, Child-Turcotte-Pugh (CTP) class B or class C—should be referred to a medical practitioner with expertise in that condition, ideally in a liver transplant center. I, C. Clinical trial data demonstrate that in the population of persons with WHEN AND IN WHOM TO INITIATE HCV THERAPY When and in Whom to Initiate HCV Therapy. Successful hepatitis C treatment results in sustained virologic response (SVR), which is tantamount to virologic cure and, as such, is expected to benefit nearly all chronically infected persons. When the US Food and Drug Administration (FDA) approved the first interferon-sparing treatment

for HCV

CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC Centers for Disease Control and Prevention (CDC). Recommendations for preventing transmission of infections among chronic hemodialysis

patients.

IMPLEMENTATION AND PRELIMINARY RESULTS OF AN EMERGENCY Schechter-Perkins EM, Miller NS, Hall J, et al. Implementation and preliminary results of an emergency department nontargeted, opt-out hepatitis C virus screening program. RECOMMENDATIONS FOR TESTING, MANAGING, AND TREATINGHOMETEST, EVALUATE, MONITORTREATMENT-NAIVETREATMENT-EXPERIENCEDUNIQUE & KEY POPULATIONS Table 1. Summary of the Process and Methods for the Guidance Development. Table 2. Rating System Used to Rate Level of Evidence and Strength of Recommendation. Table 3. Commonly Used Abbreviations and Their Expansions. References. Testing, Evaluation, and Monitoring of Hepatitis C - Browse Topics. Testing, Evaluation, and Monitoring of

Hepatitis C.

HCV IN PREGNANCY

TESTING, EVALUATION, AND MONITORING OF HEPATITIS C The following pages address testing, evaluation, and monitoring of patients with HCV before, during and after antiviral therapy. HCV Testing and Linkage to Care. When and in Whom to Initiate HCV Therapy. Overview of Cost, Reimbursement, and Cost-Effectiveness Considerations

for Hepatitis C

HCV IN CHILDREN

Although the prevalence of chronic hepatitis C is lower in children than adults, an estimated 3.5 to 5 million children worldwide have chronic HCV infection (Indolphi, 2019); (Gower, 2014).Data from the National Health and Nutrition Examination Survey (NHANES) indicate that 0.2% of 6- to 11-year-olds (31,000 children) and 0.4% of 12- to 19-year-olds (101,000 adolescents) in the US are HCV INITIAL TREATMENT OF ADULTS WITH HCV INFECTION SIMPLIFIED HCV TREATMENT* FOR TREATMENT-NAIVE ADULTS Patients in whom initial HCV treatment fails to achieve cure (SVR) should be evaluated for retreatment by a specialist, in accordance with AASLD/IDSA guidance. Until retreatment occurs, assessment for disease progression every 6 to 12 months with a hepatic function panel, CBC, and INR is recommended. HCV RESISTANCE PRIMER Introduction. Understanding principles of the emergence of drug-resistant viruses is critical when using targeted antiviral therapies. The best example of these principles can be gleaned from the study of HIV. Like HIV, HCV is an approximately 9.5 kilobase RNA virus that replicates very rapidly (billions of SIMPLIFIED HCV TREATMENT ALGORITHM FOR TREATMENT-NAIVE Calculate FIB-4 score.; Calculate CTP score: Patients with a CTP score ≥7 (ie, CTP B or C) have decompensated cirrhosis and this simplified treatment approach is not recommended.; Ultrasound of the liver (conducted within the prior 6 months): Evaluate to exclude HCC and subclinical ascites.; Medication reconciliation: Record current medications, including over-the-counter drugs and herbal MONITORING PATIENTS WHO ARE STARTING HCV TREATMENT, ARE ON The recommended pretreatment testing assumes that a decision to treat with antiviral medications has already been made and that the testing involved in deciding to treat—including testing for HCV genotype and assessment of hepatic fibrosis—has already been completed (see When and in Whom to Initiate HCV Therapy).. Prior to starting treatment, patients should be evaluated for potential drug TREATMENT-NAIVE GENOTYPE 1 Treatment-Naive Genotype 1. Four highly potent DAA combination regimens are recommended for patients with genotype 1 infection, although there are differences in the recommended regimens based on the HCV subtype, the presence or absence of baseline NS5A resistance-associated substitutions (RASs), and the presence or absence of compensated RECOMMENDATIONS FOR TESTING, MANAGING, AND TREATINGHOMETEST, EVALUATE, MONITORTREATMENT-NAIVETREATMENT-EXPERIENCEDUNIQUE & KEY POPULATIONS Table 1. Summary of the Process and Methods for the Guidance Development. Table 2. Rating System Used to Rate Level of Evidence and Strength of Recommendation. Table 3. Commonly Used Abbreviations and Their Expansions. References. Testing, Evaluation, and Monitoring of Hepatitis C - Browse Topics. Testing, Evaluation, and Monitoring of

Hepatitis C.

HCV IN PREGNANCY

TESTING, EVALUATION, AND MONITORING OF HEPATITIS C The following pages address testing, evaluation, and monitoring of patients with HCV before, during and after antiviral therapy. HCV Testing and Linkage to Care. When and in Whom to Initiate HCV Therapy. Overview of Cost, Reimbursement, and Cost-Effectiveness Considerations

for Hepatitis C

HCV IN CHILDREN

Although the prevalence of chronic hepatitis C is lower in children than adults, an estimated 3.5 to 5 million children worldwide have chronic HCV infection (Indolphi, 2019); (Gower, 2014).Data from the National Health and Nutrition Examination Survey (NHANES) indicate that 0.2% of 6- to 11-year-olds (31,000 children) and 0.4% of 12- to 19-year-olds (101,000 adolescents) in the US are HCV INITIAL TREATMENT OF ADULTS WITH HCV INFECTION SIMPLIFIED HCV TREATMENT* FOR TREATMENT-NAIVE ADULTS Patients in whom initial HCV treatment fails to achieve cure (SVR) should be evaluated for retreatment by a specialist, in accordance with AASLD/IDSA guidance. Until retreatment occurs, assessment for disease progression every 6 to 12 months with a hepatic function panel, CBC, and INR is recommended. HCV RESISTANCE PRIMER Introduction. Understanding principles of the emergence of drug-resistant viruses is critical when using targeted antiviral therapies. The best example of these principles can be gleaned from the study of HIV. Like HIV, HCV is an approximately 9.5 kilobase RNA virus that replicates very rapidly (billions of SIMPLIFIED HCV TREATMENT ALGORITHM FOR TREATMENT-NAIVE Calculate FIB-4 score.; Calculate CTP score: Patients with a CTP score ≥7 (ie, CTP B or C) have decompensated cirrhosis and this simplified treatment approach is not recommended.; Ultrasound of the liver (conducted within the prior 6 months): Evaluate to exclude HCC and subclinical ascites.; Medication reconciliation: Record current medications, including over-the-counter drugs and herbal MONITORING PATIENTS WHO ARE STARTING HCV TREATMENT, ARE ON The recommended pretreatment testing assumes that a decision to treat with antiviral medications has already been made and that the testing involved in deciding to treat—including testing for HCV genotype and assessment of hepatic fibrosis—has already been completed (see When and in Whom to Initiate HCV Therapy).. Prior to starting treatment, patients should be evaluated for potential drug TREATMENT-NAIVE GENOTYPE 1 Treatment-Naive Genotype 1. Four highly potent DAA combination regimens are recommended for patients with genotype 1 infection, although there are differences in the recommended regimens based on the HCV subtype, the presence or absence of baseline NS5A resistance-associated substitutions (RASs), and the presence or absence of compensated TESTING, EVALUATION, AND MONITORING OF HEPATITIS C The following pages address testing, evaluation, and monitoring of patients with HCV before, during and after antiviral therapy. HCV Testing and Linkage to Care. When and in Whom to Initiate HCV Therapy. Overview of Cost, Reimbursement, and Cost-Effectiveness Considerations

for Hepatitis C

HCV IN CHILDREN

Although the prevalence of chronic hepatitis C is lower in children than adults, an estimated 3.5 to 5 million children worldwide have chronic HCV infection (Indolphi, 2019); (Gower, 2014).Data from the National Health and Nutrition Examination Survey (NHANES) indicate that 0.2% of 6- to 11-year-olds (31,000 children) and 0.4% of 12- to 19-year-olds (101,000 adolescents) in the US are HCV AASLD/IDSA HCV GUIDANCE PANEL. RECOMMENDATIONS FOR TESTING AASLD/IDSA HCV guidance panel. Recommendations for testing, managing, and treating hepatitis C. Updated August 27, 2020. . 2020

.

PATIENTS WITH HIV/HCV COINFECTION This section provides guidance on the treatment of chronic HCV infection in HIV/HCV-coinfected patients. For individuals with acute HCV infection, please refer to the Acute HCV section. HIV/HCV-coinfected patients suffer from more liver-related morbidity and mortality, nonhepatic organ dysfunction, and overall mortality than HCV-monoinfected patients (Lo Re, 2014); (). SUMMARY: HCV IN PREGNANCY Recommendations for Monitoring HCV-Infected Women During Pregnancy; RECOMMENDED RATING : HCV RNA and routine liver function tests are recommended at initiation of prenatal care for HCV-antibody–positive pregnant women to assess the risk of mother-to-child transmission (MTCT) and severity of liver disease. TREATMENT OF HCV-UNINFECTED TRANSPLANT RECIPIENTS Recent data indicate increasing acceptance of organs from HCV-viremic donors among HCV-uninfected recipients (Cotter, 2019); (Potluri, 2019); (Bowring, 2018).Although no published data are available regarding the long-term (beyond 1 to 2 years) consequences to HCV-negative recipients transplanted with organs from HCV-viremic donors who are treated post-transplant with DAAs, limited short-term PATIENTS WITH DECOMPENSATED CIRRHOSIS Patients with HCV infection who have decompensated cirrhosis—moderate or severe hepatic impairment, ie, Child-Turcotte-Pugh (CTP) class B or class C—should be referred to a medical practitioner with expertise in that condition, ideally in a liver transplant center. I, C. Clinical trial data demonstrate that in the population of persons with WHEN AND IN WHOM TO INITIATE HCV THERAPY When and in Whom to Initiate HCV Therapy. Successful hepatitis C treatment results in sustained virologic response (SVR), which is tantamount to virologic cure and, as such, is expected to benefit nearly all chronically infected persons. When the US Food and Drug Administration (FDA) approved the first interferon-sparing treatment

for HCV

CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC Centers for Disease Control and Prevention (CDC). Recommendations for preventing transmission of infections among chronic hemodialysis

patients.

IMPLEMENTATION AND PRELIMINARY RESULTS OF AN EMERGENCY Schechter-Perkins EM, Miller NS, Hall J, et al. Implementation and preliminary results of an emergency department nontargeted, opt-out hepatitis C virus screening program. RECOMMENDATIONS FOR TESTING, MANAGING, AND TREATINGHOMETEST, EVALUATE, MONITORTREATMENT-NAIVETREATMENT-EXPERIENCEDUNIQUE & KEY POPULATIONS Table 1. Summary of the Process and Methods for the Guidance Development. Table 2. Rating System Used to Rate Level of Evidence and Strength of Recommendation. Table 3. Commonly Used Abbreviations and Their Expansions. References. Testing, Evaluation, and Monitoring of Hepatitis C - Browse Topics. Testing, Evaluation, and Monitoring of

Hepatitis C.

HCV IN PREGNANCY

TESTING, EVALUATION, AND MONITORING OF HEPATITIS C The following pages address testing, evaluation, and monitoring of patients with HCV before, during and after antiviral therapy. HCV Testing and Linkage to Care. When and in Whom to Initiate HCV Therapy. Overview of Cost, Reimbursement, and Cost-Effectiveness Considerations

for Hepatitis C

HCV IN CHILDREN

Although the prevalence of chronic hepatitis C is lower in children than adults, an estimated 3.5 to 5 million children worldwide have chronic HCV infection (Indolphi, 2019); (Gower, 2014).Data from the National Health and Nutrition Examination Survey (NHANES) indicate that 0.2% of 6- to 11-year-olds (31,000 children) and 0.4% of 12- to 19-year-olds (101,000 adolescents) in the US are HCV INITIAL TREATMENT OF ADULTS WITH HCV INFECTION SIMPLIFIED HCV TREATMENT* FOR TREATMENT-NAIVE ADULTS Patients in whom initial HCV treatment fails to achieve cure (SVR) should be evaluated for retreatment by a specialist, in accordance with AASLD/IDSA guidance. Until retreatment occurs, assessment for disease progression every 6 to 12 months with a hepatic function panel, CBC, and INR is recommended. HCV RESISTANCE PRIMER Introduction. Understanding principles of the emergence of drug-resistant viruses is critical when using targeted antiviral therapies. The best example of these principles can be gleaned from the study of HIV. Like HIV, HCV is an approximately 9.5 kilobase RNA virus that replicates very rapidly (billions of SIMPLIFIED HCV TREATMENT ALGORITHM FOR TREATMENT-NAIVE Calculate FIB-4 score.; Calculate CTP score: Patients with a CTP score ≥7 (ie, CTP B or C) have decompensated cirrhosis and this simplified treatment approach is not recommended.; Ultrasound of the liver (conducted within the prior 6 months): Evaluate to exclude HCC and subclinical ascites.; Medication reconciliation: Record current medications, including over-the-counter drugs and herbal MONITORING PATIENTS WHO ARE STARTING HCV TREATMENT, ARE ON The recommended pretreatment testing assumes that a decision to treat with antiviral medications has already been made and that the testing involved in deciding to treat—including testing for HCV genotype and assessment of hepatic fibrosis—has already been completed (see When and in Whom to Initiate HCV Therapy).. Prior to starting treatment, patients should be evaluated for potential drug TREATMENT-NAIVE GENOTYPE 1 Treatment-Naive Genotype 1. Four highly potent DAA combination regimens are recommended for patients with genotype 1 infection, although there are differences in the recommended regimens based on the HCV subtype, the presence or absence of baseline NS5A resistance-associated substitutions (RASs), and the presence or absence of compensated RECOMMENDATIONS FOR TESTING, MANAGING, AND TREATINGHOMETEST, EVALUATE, MONITORTREATMENT-NAIVETREATMENT-EXPERIENCEDUNIQUE & KEY POPULATIONS Table 1. Summary of the Process and Methods for the Guidance Development. Table 2. Rating System Used to Rate Level of Evidence and Strength of Recommendation. Table 3. Commonly Used Abbreviations and Their Expansions. References. Testing, Evaluation, and Monitoring of Hepatitis C - Browse Topics. Testing, Evaluation, and Monitoring of

Hepatitis C.

HCV IN PREGNANCY

TESTING, EVALUATION, AND MONITORING OF HEPATITIS C The following pages address testing, evaluation, and monitoring of patients with HCV before, during and after antiviral therapy. HCV Testing and Linkage to Care. When and in Whom to Initiate HCV Therapy. Overview of Cost, Reimbursement, and Cost-Effectiveness Considerations

for Hepatitis C

HCV IN CHILDREN

Although the prevalence of chronic hepatitis C is lower in children than adults, an estimated 3.5 to 5 million children worldwide have chronic HCV infection (Indolphi, 2019); (Gower, 2014).Data from the National Health and Nutrition Examination Survey (NHANES) indicate that 0.2% of 6- to 11-year-olds (31,000 children) and 0.4% of 12- to 19-year-olds (101,000 adolescents) in the US are HCV INITIAL TREATMENT OF ADULTS WITH HCV INFECTION SIMPLIFIED HCV TREATMENT* FOR TREATMENT-NAIVE ADULTS Patients in whom initial HCV treatment fails to achieve cure (SVR) should be evaluated for retreatment by a specialist, in accordance with AASLD/IDSA guidance. Until retreatment occurs, assessment for disease progression every 6 to 12 months with a hepatic function panel, CBC, and INR is recommended. HCV RESISTANCE PRIMER Introduction. Understanding principles of the emergence of drug-resistant viruses is critical when using targeted antiviral therapies. The best example of these principles can be gleaned from the study of HIV. Like HIV, HCV is an approximately 9.5 kilobase RNA virus that replicates very rapidly (billions of SIMPLIFIED HCV TREATMENT ALGORITHM FOR TREATMENT-NAIVE Calculate FIB-4 score.; Calculate CTP score: Patients with a CTP score ≥7 (ie, CTP B or C) have decompensated cirrhosis and this simplified treatment approach is not recommended.; Ultrasound of the liver (conducted within the prior 6 months): Evaluate to exclude HCC and subclinical ascites.; Medication reconciliation: Record current medications, including over-the-counter drugs and herbal MONITORING PATIENTS WHO ARE STARTING HCV TREATMENT, ARE ON The recommended pretreatment testing assumes that a decision to treat with antiviral medications has already been made and that the testing involved in deciding to treat—including testing for HCV genotype and assessment of hepatic fibrosis—has already been completed (see When and in Whom to Initiate HCV Therapy).. Prior to starting treatment, patients should be evaluated for potential drug TREATMENT-NAIVE GENOTYPE 1 Treatment-Naive Genotype 1. Four highly potent DAA combination regimens are recommended for patients with genotype 1 infection, although there are differences in the recommended regimens based on the HCV subtype, the presence or absence of baseline NS5A resistance-associated substitutions (RASs), and the presence or absence of compensated TESTING, EVALUATION, AND MONITORING OF HEPATITIS C The following pages address testing, evaluation, and monitoring of patients with HCV before, during and after antiviral therapy. HCV Testing and Linkage to Care. When and in Whom to Initiate HCV Therapy. Overview of Cost, Reimbursement, and Cost-Effectiveness Considerations

for Hepatitis C

HCV IN CHILDREN

Although the prevalence of chronic hepatitis C is lower in children than adults, an estimated 3.5 to 5 million children worldwide have chronic HCV infection (Indolphi, 2019); (Gower, 2014).Data from the National Health and Nutrition Examination Survey (NHANES) indicate that 0.2% of 6- to 11-year-olds (31,000 children) and 0.4% of 12- to 19-year-olds (101,000 adolescents) in the US are HCV AASLD/IDSA HCV GUIDANCE PANEL. RECOMMENDATIONS FOR TESTING AASLD/IDSA HCV guidance panel. Recommendations for testing, managing, and treating hepatitis C. Updated August 27, 2020. . 2020

.

PATIENTS WITH HIV/HCV COINFECTION This section provides guidance on the treatment of chronic HCV infection in HIV/HCV-coinfected patients. For individuals with acute HCV infection, please refer to the Acute HCV section. HIV/HCV-coinfected patients suffer from more liver-related morbidity and mortality, nonhepatic organ dysfunction, and overall mortality than HCV-monoinfected patients (Lo Re, 2014); (). SUMMARY: HCV IN PREGNANCY Recommendations for Monitoring HCV-Infected Women During Pregnancy; RECOMMENDED RATING : HCV RNA and routine liver function tests are recommended at initiation of prenatal care for HCV-antibody–positive pregnant women to assess the risk of mother-to-child transmission (MTCT) and severity of liver disease. TREATMENT OF HCV-UNINFECTED TRANSPLANT RECIPIENTS Recent data indicate increasing acceptance of organs from HCV-viremic donors among HCV-uninfected recipients (Cotter, 2019); (Potluri, 2019); (Bowring, 2018).Although no published data are available regarding the long-term (beyond 1 to 2 years) consequences to HCV-negative recipients transplanted with organs from HCV-viremic donors who are treated post-transplant with DAAs, limited short-term PATIENTS WITH DECOMPENSATED CIRRHOSIS Patients with HCV infection who have decompensated cirrhosis—moderate or severe hepatic impairment, ie, Child-Turcotte-Pugh (CTP) class B or class C—should be referred to a medical practitioner with expertise in that condition, ideally in a liver transplant center. I, C. Clinical trial data demonstrate that in the population of persons with WHEN AND IN WHOM TO INITIATE HCV THERAPY When and in Whom to Initiate HCV Therapy. Successful hepatitis C treatment results in sustained virologic response (SVR), which is tantamount to virologic cure and, as such, is expected to benefit nearly all chronically infected persons. When the US Food and Drug Administration (FDA) approved the first interferon-sparing treatment

for HCV

CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC Centers for Disease Control and Prevention (CDC). Recommendations for preventing transmission of infections among chronic hemodialysis

patients.

IMPLEMENTATION AND PRELIMINARY RESULTS OF AN EMERGENCY Schechter-Perkins EM, Miller NS, Hall J, et al. Implementation and preliminary results of an emergency department nontargeted, opt-out hepatitis C virus screening program. Skip to main content HCV GUIDANCE: RECOMMENDATIONS FOR TESTING, MANAGING, AND TREATING

HEPATITIS C

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* Methods Table 1

* Methods Table 2

* Methods Table 3 Abbreviations

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* Test, Evaluate, Monitor » * Testing and Linkage to Care

* When and in Whom

* Cost, Reimbursement, and Cost-Effectiveness

* Monitoring

* HCV Resistance

* Treatment-Naive » * Simplified: No Cirrhosis * Simplified: Comp. Cirrhosis * Decompensated Cirrhosis

* Genotype 1 »

* GT1a: No Cirrhosis

* GT1a: Compensated

* GT1b: No Cirrhosis

* GT1b: Compensated

* Genotype 2 »

* GT2 : No Cirrhosis

* GT2 : Compensated

* Genotype 3 »

* GT3 : No Cirrhosis

* GT3 : Compensated

* Genotype 4 »

* GT4 : No Cirrhosis

* GT4 : Compensated

* Genotype 5 or 6

* Treatment-Experienced »

* Genotype 1 »

* GT1a : P/R : No Cirrhosis * GT1a : P/R : Compensated * GT1b : P/R : No Cirrhosis * GT1b : P/R : Compensated * GT1 : NS3 : No Cirrhosis * GT1 : NS3 : Compensated * GT1 : Non-NS5A : No Cirrhosis * GT1 : Non-NS5A : Compensated

* GT1 : NS5A

* All GT: G/P

* All GT: SOF/VEL/VOX

* Genotype 2 »

* GT2 : P/R : No Cirrhosis * GT2 : P/R : Compensated

* GT2 : DAA

* All GT: G/P

* All GT: SOF/VEL/VOX

* Genotype 3 »

* GT3 : P/R : No Cirrhosis * GT3 : P/R : Compensated

* GT3 : DAA

* All GT: G/P

* All GT: SOF/VEL/VOX

* Genotype 4 »

* GT4 : P/R : No Cirrhosis * GT4 : P/R : Compensated

* GT4 : DAA

* All GT: G/P

* All GT: SOF/VEL/VOX * Genotype 5 or 6 »

* GT 5 or 6 : P/R

* GT 5 or 6 : DAA

* All GT: G/P

* All GT: SOF/VEL/VOX * Decompensated Cirrhosis * Unique & Key Populations » * HIV/HCV Coinfection * Decompensated Cirrhosis * Post Liver Transplant * Organs from HCV-Viremic Donors

* Renal Impairment

* Kidney Transplant

* Acute Infection

* HCV in Pregnancy

* HCV in Children

* PWID, MSM & Corrections » * People Who Inject Drugs * Men Who Have Sex With Men * Correctional Settings

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MenuHome »   Table of Contents   Introduction   Methods »Â Â Â Â Â Â Methods Table 1      Methods Table 2      Methods Table 3 Abbreviations   ReferencesTest, Evaluate, Monitor »   Testing and Linkage to Care   When and in Whom   Cost, Reimbursement, and Cost-Effectiveness   Monitoring   HCV ResistanceTreatment-Naive »Â Â Â Simplified: No Cirrhosis   Simplified: Comp. Cirrhosis   Decompensated Cirrhosis   Genotype 1 »Â Â Â Â Â Â GT1a: No Cirrhosis      GT1a: Compensated      GT1b: No Cirrhosis      GT1b: Compensated   Genotype 2 »      GT2 : No Cirrhosis      GT2 : Compensated   Genotype 3 »Â Â Â Â Â Â GT3 : No Cirrhosis      GT3 : Compensated   Genotype 4 »      GT4 : No Cirrhosis      GT4 : Compensated   Genotype 5 or 6Treatment-Experienced »   Genotype 1 »      GT1a : P/R : No Cirrhosis      GT1a : P/R : Compensated      GT1b : P/R : No Cirrhosis      GT1b : P/R : Compensated      GT1 : NS3 : No Cirrhosis      GT1 : NS3 : Compensated      GT1 : Non-NS5A : No Cirrhosis      GT1 : Non-NS5A : Compensated      GT1 : NS5A      All GT: G/P      All GT: SOF/VEL/VOX   Genotype 2 »      GT2 : P/R : No Cirrhosis      GT2 : P/R : Compensated      GT2 : DAA      All GT: G/P      All GT: SOF/VEL/VOX   Genotype 3 »      GT3 : P/R : No Cirrhosis      GT3 : P/R : Compensated      GT3 : DAA      All GT: G/P      All GT: SOF/VEL/VOX   Genotype 4 »      GT4 : P/R : No Cirrhosis      GT4 : P/R : Compensated      GT4 : DAA      All GT: G/P      All GT: SOF/VEL/VOX   Genotype 5 or 6 »      GT 5 or 6 : P/R      GT 5 or 6 : DAA      All GT: G/P      All GT: SOF/VEL/VOX   Decompensated CirrhosisUnique & Key Populations »Â Â Â HIV/HCV Coinfection   Decompensated Cirrhosis   Post Liver Transplant   Organs from HCV-Viremic Donors   Renal Impairment   Kidney Transplant   Acute Infection   HCV in Pregnancy   HCV in Children   PWID, MSM & Corrections »Â Â Â Â Â Â People Who Inject Drugs      Men Who Have Sex With Men      Correctional SettingsAbout »Â Â Â Announcements   Organizations   Panel   Disclosures   Process   Citing and Permissions   Survey   Website Policies   Contact Start Here: Choose a patient profile from the menu above.

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WELCOME TO HCVGUIDELINES.ORG The AASLD and IDSA in partnership with the panel have created an updated web experience to facilitate easier and faster access to this important resource. Please select a patient profile from the menu above, click on a guidance section below, or use the search box to

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__CONTENTS AND INTRODUCTION - _Select a Page_ * Full Table of Contents

* Introduction

* Methods

* Table 1. Summary of the Process and Methods for the Guidance

Development

* Table 2. Rating System Used to Rate Level of Evidence and Strength

of Recommendation

* Table 3. Commonly Used Abbreviations and Their Expansions

* References

__TESTING, EVALUATION, AND MONITORING OF HEPATITIS C - _Browse Topics_ * Testing, Evaluation, and Monitoring of Hepatitis C * HCV Testing and Linkage to Care * When and in Whom to Initiate HCV Therapy * Overview of Cost, Reimbursement, and Cost-Effectiveness Considerations for Hepatitis C Treatment Regimens * Monitoring Patients Who Are Starting HCV Treatment, Are on Treatment, or Have Completed Therapy * HCV Resistance Primer __INITIAL TREATMENT OF HCV INFECTION - _Choose Patient Genotype_ * Initial Treatment of HCV Infection * Simplified HCV Treatment for Treatment-Naive Patients Without

Cirrhosis

* Simplified HCV Treatment Algorithm for Treatment-Naive Adults With Compensated Cirrhosis * Treatment-Naive Genotype 1 * Treatment-Naive Genotype 2 * Treatment-Naive Genotype 3 * Treatment-Naive Genotype 4 * Treatment-Naive Genotype 5 or 6 __RETREATMENT OF PERSONS IN WHOM PRIOR THERAPY HAS FAILED - _Choose

Patient Genotype_

* Retreatment of Persons in Whom Prior Therapy Has Failed * Treatment-Experienced Genotype 1 * Treatment-Experienced Genotype 2 * Treatment-Experienced Genotype 3 * Treatment-Experienced Genotype 4 * Treatment-Experienced Genotype 5 or 6 * Glecaprevir/Pibrentasvir Treatment Failures (All Genotypes)​ * Sofosbuvir/Velpatasvir/Voxilaprevir Treatment Failure (All

Genotypes)

__MANAGEMENT OF UNIQUE & KEY POPULATIONS - _Review Recommendations_ * Management of Unique Populations with HCV Infection * Patients With HIV/HCV Coinfection * Patients With Decompensated Cirrhosis * Patients Who Develop Recurrent HCV Infection Post-Liver

Transplantation

* Treatment of HCV-Uninfected Transplant Recipients Receiving Organs From HCV-Viremic Donors * Patients With Renal Impairment * Kidney Transplant Patients * Management of Acute HCV Infection

* HCV in Pregnancy

* HCV in Children

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