Overview

These are the first guidelines dealing with hepatitis C treatment produced by the World Health Organization (WHO) and complement existing guidance on the prevention of transmission of bloodborne viruses, including HCV. They are intended for policy-makers, government officials, and others working in low- and middleincome countries who are developing programmes for the screening, care and treatment of persons with HCV infection.

These guidelines serve as a framework that can allow the expansion of clinical services to patients with HCV infection, as they provide key recommendations in these areas and discuss considerations for implementation. The guidelines are also intended for health-care providers who care for persons with HCV infection in low- and middle-countries and provide them guidance in the management of patients infected with HCV.

Contents

• ACKNOWLEDGEMENTS
• ABBREVIATIONS AND ACRONYMS
• GLOSSARY OF TERMS
• EXECUTIVE SUMMARY
• 1. SCOPE AND OBJECTIVES
  • Introduction and objectives
  • Target audience
  • Related WHO materials and guidelines
• 2. BACKGROUND
  • 2.1 Epidemiology of hepatitis C
  • 2.2 Hepatitis C virus
  • 2.3 Natural history of HCV infection
  • 2.4 Prevention of HCV infection
  • 2.5 Screening for HCV infection
  • 2.6 Care of patients with HCV infection
  • 2.7 Treatment of patients with HCV infection
  • 2.8 Cost–effectiveness of treatment
• 3. GUIDING PRINCIPLES
  • 3.1 Human rights
  • 3.2 Access to health care
  • 3.3 Service provision
  • 3.4 Integrated health care
• 4. METHODS
  • WHO guideline development process
• 5. RECOMMENDATIONS ON SCREENING
  • 5.1 Screening to identify persons with HCV infection
  • 5.2 When to confirm a diagnosis of chronic HCV infection
• 6. RECOMMENDATIONS ON CARE OF PEOPLE INFECTED WITH HCV
  • 6.1 Screening for alcohol use and counselling to reduce moderate and high levels of alcohol intake
  • 6.2 Assessing the degree of liver fibrosis and cirrhosis
• 7. RECOMMENDATIONS ON TREATMENT
  • 7.1 Assessment for HCV treatment
  • 7.2 Treatment with pegylated interferon and ribavirin
  • 7.3 Treatment with telaprevir or boceprevir
  • 7.4 Introduction to recommendations concerning sofosbuvir and simeprevir
  • 7.5 Treatment with sofosbuvir
  • 7.6 Treatment with simeprevir
• 8. CLINICAL CONSIDERATIONS
  • Genotype testing
  • Q80K mutation testing
  • IL28B testing
  • Contraindications to treatment
  • Monitoring for adverse reactions and treatment response
  • 8.1 Monitoring for toxicity
  • 8.2 Dose modification
  • 8.3 Monitoring for efficacy
• 9. SPECIAL CONSIDERATIONS FOR SPECIFIC POPULATIONS
  • 9.1 People who inject drugs
  • 9.2 Persons with HIV and HCV coinfection
  • 9.3 Children and adolescents
  • 9.4 Persons with liver cirrhosis
  • 9.5 Persons with HBV and TB coinfection
  • 9.6 Persons with renal impairment
• 10. OPERATIONAL AND IMPLEMENTATION ISSUES
  • 10.1 Service planning
  • 10.2 Service delivery
  • 10.3 Future considerations
  • 10.4 Dissemination, monitoring and implementation of the Guidelines for the screening, care and treatment of persons with hepatitis C infection
• 11. REFERENCES
• APPENDICES
  • Appendix 1 PICO QUESTIONS for the WHO Hepatitis C Treatment Guidelines Evidence Reviews
  • Appendix 2 Example of GRADE decision-making table
  • Appendix 3 Systematic reviews and evidence summaries
  • Appendix 4 Decision-making tables
  • Appendix 5 Technical report on monitoring during treatment
  • Appendix 6 Summary of declared interests of members of Guidelines Development Group for the development of WHO HCV guidelines for screening, care, and treatment of persons with HCV infection

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