Hepatitis C guidance: AASLD‐IDSA recommendations for testing, managing, and treating adults infected with hepatitis C virus

Case report: successful retreatment of hepatitis C genotype 1b infection with sofosbuvir + simeprevir in a patient with cirrhosis who had prior virologic relapse after treatment with daclatasvir and asunaprevir

“…It is recommended that patients without NS5A RAVs should receive retreatment with ledipasvir/sofosbuvir with RBV for 24 weeks, those with NS5A RAVs but without NS3 RAVs receive simeprevir/sofosbuvir with RBV for 24 weeks, while sofosbuvir combined with either elbasvir/grazoprevir or paritaprevir/ritonavir/ombitasvir/dasabuvir may be efficacious in patients with NS5A and NS3 RAVs (data are limited) 5.…”

“…This study and the current case report demonstrate that high rates of retreatment SVR can be achieved without the use of RBV or extending retreatment duration to 24 weeks. The addition of RBV and extension of treatment duration to 24 weeks is recommended in treatment guidelines as mechanisms to increase response, and delay or prevent the emergence of RAVs, particularly when low barrier DAAs (e.g., protease inhibitors) are used 4, 5.…”

Hepatitis C virus infection in children and adolescents

“…Sequential testing of serum aminotransferase concentrations and regular office visits to assess for evidence of disease progression or complications is suggested. In adults with chronic hepatitis C infection, recent advancements have enabled the validation of both circulating biomarker tests and vibration‐controlled transient elastography in determining the stage of fibrosis,3, 124, 125, 126, 127, 128 progression and regression of fibrosis,129, 130, 131 as well as their use in determining liver‐related complications and overall survival 132, 133. Validation of these technologies in children and adolescents is emerging; however, the low incidence of progressive hepatitis C infection in the pediatric population will require large cohorts with extended follow‐up to determine their efficacy.…”

“…The current Centers for Disease Control recommendations for HCV screening and advances in HCV treatment are anticipated to diminish the clinical burden of the disease; however, medication cost and access to care remain significant barriers 2. In order to provide a more structured approach to the dynamic landscape of HCV, adult‐centric guidelines have been established 3. These provide health care professionals with timely guidance as new therapies become available and are integrated into treatment regimens.…”

“…HCV infection across the pediatric age spectrum differs from infection acquired later in life in a variety of ways, including modes of transmission, rates of spontaneous clearance or progression of fibrosis, the potential duration of chronic infection when acquired at birth, and significantly, available treatment options 4. While several reviews have recently been published regarding aspects of HCV infection in adults,3, 5, 6 our goal is to present a practical overview of the epidemiology, diagnosis, clinical features, natural history, and management of HCV infection in children and adolescents.…”