Recommendations for treatment of hepatitis C. Polish Group of HCV Experts – 2015

Diseases with hepatitis C virus (HCV) aetiology are rarely diagnosed on the basis of the clinical picture because they are usually asymptomatic or only mildly symptomatic for many years. Consequently, diagnosis is often preceded by incidental detection of laboratory markers indicative of HCV infection. Studies conducted in Poland in recent years have demonstrated that anti-HCV antibodies are found in 0.9-1.9% of Poland’s inhabitants, depending on the study population and methodology. The studies have indisputably confirmed the presence of HCV RNA in the blood, indicating active infection, at 0.6%. This figure is equivalent to approximately 200,000 adult members of the Polish population who require urgent diagnosis and treatment. The estimated number of patients diagnosed during the period of availability of HCV therapy is approximately 30,000, which corresponds to a detection rate of 15% [1-3].
Around 20-40% of acute infections are believed to resolve spontaneously. Hepatitis C virus infection only becomes apparent after many years. One in five chronic infection cases are diagnosed at the stage of advanced pathological changes in the liver, i.e. cirrhosis or, less commonly, hepatocellular carcinoma. Hepatitis C virus infection also triggers a range of extrahepatic syndromes – usually cryoglobulinaemia, which produces clinical manifestations in 5-25% of cases [4].
Treatment should be provided to all HCV-infected patients diagnosed with acute and chronic hepatitis and the fibrosis stage F ≥ 1. The primary aim of therapy is to halt or reverse histological lesions, particularly liver fibrosis [5-7].
Treatment should preferably be initiated at early stages of the disease due to higher efficacy. However, in the event of problems with the availability of drugs, priority should be given to the following sub-groups of patients:
• with liver fibrosis (F ≥ 3),
• waiting for liver transplantation or who have had liver transplantation,
• undergoing haemodialysis, especially patients waiting for kidney transplantation,
• with extrahepatic manifestations of HCV infection (membranous glomerulonephritis, cryoglobulinaemia, lichen planus, cutaneous porphyria, B-NHL lymphomas and others),
• with hepatocellular carcinoma with HCV aetiology,
• co-infected with hepatitis B virus (HBV).

Acute HCV infection

The sole objective criterion in the diagnosis of acute hepatitis C (AHC) is the presence of laboratory markers...


View full text...