A Simplified Algorithm for the Management of Hepatitis C Infection

Elimination of hepatitis C virus (HCV) infection as a public health threat is a goal of the World Health Organization. Official treatment guidelines are comprehensive and may be most appropriate for experienced treaters of HCV; however, global elimination of HCV infection will require the engagement of frontline health care providers (HCPs) to increase the capacity to treat patients. Thus, a simplified treatment algorithm is needed to provide guidance to non-HCV specialists. To accomplish this, a panel of 13 HCV specialists held a consensus meeting in September 2018 to create an easy-to-use, effective, safe, and scalable algorithm for the management and treatment of HCV infection through discussion and collective decision-making. The algorithm begins with universal HCV screening and diagnosis by testing for HCV antibody with reflex to polymerase chain reaction to detect HCV RNA. The pretreatment evaluation uses platelet-based stratification to initially assess fibrosis, and the pan-genotypic regimens glecaprevir/pibrentasvir or sofosbuvir/velpatasvir are recommended for treatment. Unless clinically indicated, on-treatment monitoring is optional. Confirmation of cure (undetectable HCV RNA 12 weeks posttreatment) is followed by harm-reduction measures, as well as surveillance for hepatocellular carcinoma every 6 months in patients with advanced fibrosis/cirrhosis. This algorithm provides guidance for management of uncomplicated cases of HCV by frontline HCPs and indicates when referral to an HCV specialist is warranted. The algorithm was created to enable more HCPs to screen for and manage HCV infection, and thus contribute to its elimination.