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Post Info TOPIC: Updated Treatment Recommendations from AASLD - 11th Aug 2014


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RE: Updated Treatment Recommendations from AASLD - 11th Aug 2014
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Hey Guys:

If you are planning to treat right away now would be a good time to find out your Metavir score, if you haven't done so already, because under the new guidelines not having a Metavir score could definitely delay treatment.

The Metavir score is determined by liver biopsy or a fibroscan will suffice.  I doubt most insurance companies will be permitting a fibrosure score (because they are notoriously unreliable) where the priority ranking is solely established by your level of fibrosis. 



__________________

Diagnosed in 2011, Incivek triple in 2011, tx discontinued, Genotype 1a, CT, VL 7mill, cirrhosis dx in 2012, age 67, waiting for new DAAs.



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This is big news.  Thanks, Jill.

So, this pretty much spells it out.  There are no exact time lines so docs should have the latitude to treat both Class 1 and Class II patients fairly quickly. My guess is that the October S/L combo will go mainly to the Highest Priority patients. The High Priority Patients and any Highest Priority patients that haven't been treated yet will get the December Abbvie combo (or whatever is cheapest).  Insurance companies will need to fall in line with this plan too.  

When and in Whom to Initiate HCV Therapy Table 1. Settings of Liver-Related Complications and Extrahepatic Disease in Which HCV Treatment is Most Likely to Provide the Most Immediate and Impactful Benefits

Highest Priority for Treatment Owing to Highest Risk for Severe Complications

Advanced fibrosis (Metavir F3) or compensated cirrhosis (Metavir F4)

Rating: Class I, Level A

Organ transplant

Rating: Class I, Level B

Type 2 or 3 essential mixed cryoglobulinemia with end-organ manifestations (eg, vasculitis)

Rating: Class I, Level B

Proteinuria, nephrotic syndrome, or membranoproliferative glomerulonephritis

Rating: Class IIa, Level B

High Priority for Treatment Owing to High Risk for Complications

Fibrosis (Metavir F2)

Rating: Class I, level B

HIV-1 coinfection

Rating: Class I, Level B

HBV coinfection

Rating: Class IIa, Level C

Other coexistent liver disease (eg, NASH)

Rating: Class IIa, Level C

Debilitating fatigue

Rating: Class IIa, Level B

Type 2 Diabetes mellitus (insulin resistant)

Rating: Class IIa, Level B

Porphyria cutanea tarda

Rating: Class IIb, Level C

Ratings refer to the strength and level of evidence with regard to benefits of treatment in these settings.

When and in Whom to Initiate HCV Therapy Table 2. Persons Whose Risk of HCV Transmission is High and in Whom HCV Treatment May Yield Transmission Reduction Benefits

High HCV Transmission Risk*

MSM with high-risk sexual practices

Active injection drug users

Incarcerated persons

Persons on long-term hemodialysis

Rating: Class IIa, Level C

*Patients at high risk of transmitting HCV should be counseled on ways to decrease transmission and minimize the risk of reinfection.



__________________

Diagnosed in 2011, Incivek triple in 2011, tx discontinued, Genotype 1a, CT, VL 7mill, cirrhosis dx in 2012, age 67, waiting for new DAAs.



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HCV Treatment Recommendations Now Includes Information on Prioritizing Patients Under Limited Resources

11th Aug 2014 - The American Association for the Study of Liver Disease (AASLD) and the Infectious Diseases Society of America, in collaboration with the International Antiviral Society-US, today released the latest section of their website which assists clinicians treating patients with hepatitis C virus (HCV). The new section is titled, "When and in Whom to Initiate HCV Therapy."

www.hcvguidelines.org,

The addition of the new section now offers clinicians information on how to prioritize treatment for those patients who will derive the most benefit or will have the greatest impact on limiting further HCV transmission. Highest priority should be given to patients with advanced fibrosis with compensated cirrhosis and liver transplant recipients and high priority given to patients at high risk for liver-related complications and severe extra-hepatic HCV complications. The guidance provides further detailed information on additional conditions that warrant prioritization of treatment.

Link to full updated report...

http://hcvguidelines.org/full-report-view

 

 



__________________

Jill 

(71 yo, lives in UK)

Was Gen 3a, 

24wks Peg Ifn/Riba, Sep 2010 - Mch 2011

UND @ Wk.4, UND @ EOT, 

SVR Nov 2011 --> Still UND @ EOT + 4 yrs.

 

 

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