Several new DAAs have been approved since WHO issued its first hepatitis C guidelines in 2014. Here are the new guideline highlights.
Well-tolerated interferon-free DAA regimens can now cure more than 90% of people with chronic hepatitis C, usually in 8-12 weeks, with good outcomes even for hard-to-treat patients such as those with advanced liver cirrhosis and non-responders to previous treatment attempts. In contrast, the older interferon-based therapy lasted 6-12 months, caused difficult side-effects and only cured about half of patients who tried it.
The goal of the WHO guidelines is to provide evidence-based treatment recommendations using DAA-only combinations, if possible, suggesting ‘preferred’ regimens based on a patient’s HCV genotype and clinical history.
- The guidelines simplify treatment decisions by recommending three regimens for patients without liver cirrhosis and an additional two for those with cirrhosis.
- For people with HCV genotype 1 with and without cirrhosis, treatment with sofosbuvir/ledipasvir (Harvoni) or sofosbuvir (Sovaldi) daclatasvir (Daklinza), with or without ribavirin, is recommended.
- Alternative regimens for genotype 1 include simeprevir (Olysio) sofosbuvir or ombitasvir/paritaprevir/ritonavir/dasabuvir (Viekirax/Exviera), with or without ribavirin.
- For people with genotype 2 with and without cirrhosis, the recommended regimen is sofosbuvir/ribavirin, with sofosbuvir/daclatasvir as an alterative.
- For people with genotype 3, sofosbuvir/daclatasvir or sofosbuvir/ribavirin are recommended for those without cirrhosis, and sofosbuvir/daclatasvir/ribavirin for those with cirrhosis.
- Recommended regimens for people with genotype 4 are the same as those for genotype 1.
- For people with HCV genotype 5 or 6 with and without cirrhosis, the recommended DAA regimen is sofosbuvir/ledipasvir.
- An interferon-containing regimen – sofosbuvir pegylated interferon/ribavirin – remains an option for patients with HCV genotype 3 with cirrhosis, and for those with genotypes 5 or 6 with or without cirrhosis.
- Regimens containing sofosbuvir, daclatasvir and ledipasvir can be prescribed for people with decompensated cirrhosis, but these patients should not use regimens containing paritaprevir, simeprevir or pegylated interferon as they can cause liver failure and death.
“The updated guidelines are intended to promote the scale-up of HCV treatment, particularly in low- and middle-income countries where few people currently have access to hepatitis treatment, despite also being where most people with HCV live,” according to a WHO press statement. “Because the prices are rapidly dropping, and because the medicines are easy to use, they have the potential to dramatically reduce the number of deaths due to hepatitis C infection.”