AGA Releases Position Statement on Management of Hepatitis C

The demand to manage hepatitis C virus (HCV) infection has increased over the past decade, and current predictions are that HCV-associated morbidity and mortality rates will escalate in the next 20 years. The American Gastroenterological Association (AGA) has released a review and position statement on the management of HCV infection. The report was published in the January 2006 issue of Gastroenterology.

Routine screening is not necessary for asymptomatic adults with a low probability of infection. Persons in high-risk groups (e.g., injection drug users, immigrants from countries with high rates of infection) should be tested for HCV.

Potential candidates for antiviral therapy include patients who have a reactive enzyme immunoassay for antibody to HCV and those with HCV RNA or compensated liver disease. Elevated alanine transaminase and aspartate transaminase levels are not required for therapy.

Preferred therapy for previously untreated patients with HCV infection consists of a weekly subcutaneous injection of pegylated interferon alfa and oral ribavirin (Rebetol) taken daily. Pegylated interferon is considered the best treatment for patients with indications for antiviral therapy but who have contraindications to ribavirin. Two pegylated interferon alfa preparations are available: pegylated interferon alfa-2a (Pegasys), which is administered at a fixed 180-mcg dose, and pegylated interferon alfa-2b (PEG-Intron), which is administered at a dose of 1.5 mcg per kg.

HCV RNA levels should be monitored using the same quantitative amplification assay at baseline and 12 weeks. An early virologic response (i.e., a reduction in HCV RNA levels of at least 2-log₁₀ within the first 12 weeks of therapy) is a valuable clinical milestone. Without the early virologic response, the chance of sustained virologic response is 3 percent or less. During therapy, clinical and virologic monitoring should be performed at intervals of once per month to once every three months.

Treatment recommendations may vary for other patients, including those with cirrhosis, acute hepatitis C, hematologic disorders, end-stage renal disease, extra-hepatic disease, and human immunodeficiency virus, as well as patients who are injection-drug or alcohol users, have had a liver transplant, or have relapsed or did not respond to previous HCV therapy. Treatment is not recommended for patients younger than three years.