[Hepatitis C virus infection. From clinical guidelines to clinical practice and personalization of cure.]

Area of Science:

• Hepatology
• Virology
• Clinical Medicine

Background:

• Clinical guidelines offer clear indications for chronic Hepatitis C (HCV) treatment.
• However, complex patient scenarios necessitate clinical expertise beyond established protocols.

Purpose of the Study:

• To highlight areas in chronic HCV management where clinical judgment is crucial.
• To discuss challenges in antiviral therapy for decompensated liver disease, retreatment, and post-eradication follow-up.

Main Methods:

• Review of current clinical guidelines and literature on HCV management.
• Discussion of specific patient populations requiring individualized treatment decisions.

Main Results:

• Antiviral therapy for decompensated HCV patients, especially those awaiting liver transplantation or with comorbidities, remains challenging.
• Retreatment after failure of NS5A inhibitor regimens, particularly for HCV genotype 3 with cirrhosis, lacks solid recommendations.
• Follow-up strategies for non-cirrhotic patients achieving viral eradication are debated due to limited prospective data.

Conclusions:

• Clinical experience is essential for managing complex chronic HCV cases, including decompensated disease and retreatment scenarios.
• Future recommendations may involve evaluating early viral kinetics to personalize antiviral treatment duration.