Guidelines Have a Key Role in Driving HCV Elimination by Advocating for Simple HCV Care Pathways

Abstract

The availability of pangenotypic direct-acting antivirals for treatment of hepatitis C (HCV) has provided an opportunity to simplify patient pathways. Recent clinical practice guidelines have recognised the need for simplification to ensure that elimination of HCV as a public health concern remains a priority. Despite the move towards simplified treatment algorithms, there remains some complexity in the recommendations for the management of genotype 3 patients with compensated cirrhosis. In an era where additional clinical trial data are not anticipated, clinical guidance should consider experience gained in real-world settings. Although more experience is required for some pangenotypic therapeutic options, on the basis of published real-world data, there is already sufficient evidence to consider a simplified approach for genotype 3 patients with compensated cirrhosis. The coronavirus disease 2019 (COVID-19) pandemic has highlighted the need to minimise the need for complex patient pathways and clinical practice guidelines need to continue to evolve in order to ensure that patient outcomes remain optimised.

Sofosbuvir–velpatasvir in adults with hepatitis C virus infection and compensated cirrhosis in Japan

“…An expanded indication for sofosbuvir–velpatasvir could be of benefit in Japan's efforts to meet the World Health Organization goal of eliminating HCV as a public health problem by 2030 1,25,26 . Removing the need for histologic evaluation and genotyping with sofosbuvir–velpatasvir could streamline the HCV treatment pathway and ultimately lower barriers to cure 27 . In addition, in regions where prevalence of HCV is highest in older populations, such as Japan, regimens free of protease inhibitors would benefit individuals with comorbidities and taking multiple prescribed medications.…”

Pan-Genotypic Direct-Acting Antiviral Agents for Undetermined or Mixed-Genotype Hepatitis C Infection: A Real-World Multi-Center Effectiveness Analysis

“…This is of particular importance in resource-limited countries, high-prevalence populations such as PWID, or people in outreach onsite treatment programs such as prisons [ 38 ]. Since the introduction of pan-genotypic DAA regimens, several society guidelines have removed the requirement for HCV genotype documentation before prescribing such DAAs [ 39 ] due to their high efficacy. Such a simplified treatment pathway is particularly beneficial for people in the PWID population, homeless patients, migrants, and incarcerated people in the era of the COVID-19 pandemic.…”

Hepatitis C diagnosis slowdown in high-prevalence groups and using decentralised diagnostic strategies during the COVID-19 pandemic

“…Additionally, given the least impact achieved at the hospital as opposed to the primary level during the pandemic, promoting diagnosis at the primary care level should be considered (23,24). However, telemedicine, which in previous studies has proven its effectiveness in facilitating access to the health system for difficult-totreat populations (25,26), and despite its increased use after the pandemic, it has yet to show its ability to effectively improve the diagnosis rate, since some authors postulate it as a barrier in itself (10). According to our study, the greatest impact of the pandemic took place in drug treatment centres and prisons, despite the obvious benefits of telemedicine in those settings (15,25).…”