Population modeling performed in 2011 posited that if new antiviral regimens consistently resulted in an 80% response rate, and if 50% of all HCV patients were treated, then, within 10 years, there would be a 15% reduction in cases of cirrhosis, a 30% reduction in cases of HCC, and 34% fewer deaths from liver disease, indicating the substantial effects that treatment would have in reducing liver disease morbidity .In New York State (including New York City), the mortality rate associated with HCV increased from 4.0 per 100,000 population in 2001 to 5.5 per 100,000 population in 2015 .Hepatitis C Virus Infection Guideline Committee, July 2017 This guideline was developed by the New York State (NYS) Department of Health (DOH) AIDS Institute (AI) Clinical Guidelines Program, which is a collaborative effort between the NYSDOH AI Office of the Medical Director and the Johns Hopkins University School of Medicine, Division of Infectious Diseases.
The DAA regimens make cure possible for many patients, but these patients must first be identified, engaged in care, offered appropriate screening for status of their HCV infection/disease, and have access to treatment.
The goal of HCV therapy is a sustained virologic response (SVR), which is defined as the absence of detectable HCV RNA at least 12 weeks after completion of therapy. DAA regimens have been associated with an SVR rate of more than 90% and have excellent tolerability in both treatment-naive and treatment-experienced patients with and without cirrhosis [2-8].
The resulting recommendations are based on an extensive review of the medical literature and reflect consensus among this panel of HCV experts.
Each recommendation is rated for strength and for quality of the evidence (see Recommendation Rating Scheme, below).
The NYS Department of Health (DOH) has developed specific criteria, listed below, to define experienced HCV care providers who are qualified to prescribe HCV antiviral therapy.
Clinical experience and appropriate continuing education are both important to ensure that HCV medications are prescribed safely and correctly and that all patients receive the highest quality of care.From 1999 through 2013, deaths from primary liver cancer in the United States increased at the highest rate of all cancer sites, and liver cancer incidence rates increased sharply, second only to thyroid cancer .Men had more than twice the incidence rate of liver cancer than women, and rates increased with age for both sexes.The availability of safe and effective regimens of oral DAAs has revolutionized HCV care.New DAA agents and new combinations of agents continue to be tested and approved, and these efficacious combinations have replaced earlier treatments as the standard of care for curing chronic HCV infection.After adjusting for populations not sampled in the NHANES surveys, such as the incarcerated and homeless, the researchers estimated that 3.5 million people were living with chronic HCV infection in the United States [7,8].