Management of Chronic Hepatitis C: Consensus Guidelines

Abstract

Since the last consensus conference on the management of chronic viral hepatitis, a number of studies looking at modifications of the standard course of treatment have been published. These changes have been sufficiently substantive to warrant review to determine whether any changes in the recommended treatment algorithms are needed. A consensus development conference was held in January 2007, and the present document highlights the results of the presentations and discussion about these issues. It reviews the epidemiology of hepatitis C in Canada, treatment of acute hepatitis C and new algorithms in chronic hepatitis C, including retreatment of previous treatment failures. In addition, sections on management of hepatitis C in special populations have been updated. There is also a section on the use of hematopoietic growth factors to help manage patients on therapy. The document should be read in conjunction with the previous document to identify changes. Some recommendations made in the previous document remain and are not discussed here.

Natural Killer Cell Subsets Distribution in Spontaneously Resolved and Chronic Persistent Hepatitis C Virus Infection

“…Correlation analysis revealed that the percentage of CD158b + NK cells significantly positively correlated with serum AST and ALT levels in chronic HCV patients. This agreed with Vidal-Castineira et al [10] and Hui-Fan et al [8].The later explained that the impaired immune response caused by CD158b leads to exaggerated hepatocytes damage by HCV with high liver enzymes.…”

“…They were anti-HCV antibody positive and had detectable serum level of HCV RNA by PCR for at least 6 months [10].…”

Antiviral Therapy in HCV-Infected Decompensated Cirrhotics

“…Although more data and experience is needed to establish definite protocols in genotypes 4, 5 & 6 cases, current evidence suggests treating them as genotype 1 cases. 23 Tables 5 & 6 shown to improve responses in such cases, but it is too premature to recommend it. † The newly recommended week 4 qualitative HCV RNA assay helps modify the duration of the therapy based on viral kinetics.…”

“…60,000IU/week) with an aim to achieve & maintain Hb level of ≥10g/dL (return to the pretreatment level is NOT the aim). 23 2. Another study suggested starting EPO therapy at a lower dose of 4,000IU subcutaneously thrice weekly (12,000IU/week) and then increasing the dose depending upon the response.…”

“…Although the final SVR rates attained in such patients are lower, 21,23 successful antiviral therapy is potentially lifesaving which supports the rationale for implementing HCV treatment in these patients.…”