Recommendations for the treatment of hepatitis C issued by the Polish Group of HCV Experts – 2016

Introduction

Diseases of hepatitis C virus (HCV) aetiology are rarely diagnosed on the basis of the clinical picture, as their course is usually asymptomatic or only mildly symptomatic for many years. Consequently, diagnosis is frequently preceded by an incidental detection of laboratory markers indicative of HCV infection. Studies conducted in Poland in recent years have shown that anti-HCV antibodies are found in 0.9-1.9% of the Polish population, depending on the study population and the methodology applied. The studies have consistently confirmed the presence of HCV-RNA in the blood, indicating active infection, at 0.6%. The figure corresponds to approx. 200,000 adult Poles who require immediate diagnosis and treatment. The number of patients diagnosed during the period of HCV therapy availability is estimated to be approx. 35,000, which is equivalent to the detection rate of 17.5% [1-3]. Hepatitis C virus genotype (GT) 1 is the most prevalent one among the Polish population: it is found in 80% of all infected individuals, the most common (98%) sub-genotype being GT1b. GT3 (14%) and GT4 (5%) are less common, and infections with genotypes 2, 5 and 6 may be diagnosed sporadically [4].
Around 20-40% of acute infections are thought to resolve spontaneously. Chronic HCV infection only manifests itself after many years, and one in five patients develop advanced pathological changes in the liver including cirrhosis or hepatocellular carcinoma (HCC). Hepatitis C virus infection also induces a number of extrahepatic syndromes, most typically cryoglobulinemia which gives rise to clinical manifestations in 5-25% of cases, and B-cell non-Hodgkin lymphoma (B-NHL) [5].
All patients with chronic HCV infection should receive treatment. The sooner the therapy is initiated, the better the outcome and the lower the cost. However, if access to therapy is restricted, priority should be given to those patients whose HCV infection, in the assessment of an infectious diseases specialist, can lead to a deterioration of the quality of life or death within a short time. The aims of treatment are to eliminate HCV infection and, consequently, to stop or reverse histological lesions, and to reduce the risk of development of hepatocellular carcinoma and prevent the spread of the infection to other people [6, 7].

Acute HCV infection

The only objective criterion in the diagnosis of acute hepatitis C (AHC) is the identification of AHC-associated...


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