Guideline

Updated recommendations on treatment of adolescents and children with chronic HCV infection, and HCV simplified service delivery and diagnostics.

Year of Publication

2022

Issuing Institution

World Health Organization

Links

WHO IRIS

Recommendations

21 included recommendations

(Decentralization) We recommend delivery of HCV testing and treatment at peripheral health or community-based facilities, and ideally at the same site, to increase access to diagnosis, care and treatment. These facilities may include primary care, harm reduction sites, prisons and HIV/antiretroviral therapy (ART) clinics as well as community-based organizations and outreach services.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

We recommend integration of HCV testing and treatment with existing care services at peripheral health facilities. These services may include primary care, harm reduction (needle and syringe programme (NSP)/opioid agonist maintenance therapy (OAMT) sites), prisons and HIV/antiretroviral therapy (ART) services

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

Task sharing. We recommend delivery of HCV testing, care and treatment by trained nonspecialist doctors and nurses to expand access to diagnosis, care and treatment

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

Directly following a positive HCV antibody serological test result, the use of quantitative or qualitative nucleic acid testing (NAT) for detection of HCV ribonucleic acid (RNA) is recommended as the preferred strategy to diagnose viraemic infection.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

An assay to detect HCV core (p22) antigen, which has comparable clinical sensitivity to laboratory-based HCV RNA NAT assays, can be an alternative approach to diagnose HCV viraemic infection.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Moderate

Point-of-care (POC) HCV RNA assays: The use of HCV point-of-care (POC) viral load NAT assay can be an alternative approach to laboratory-based HCV RNA NAT assays to diagnose HCV viraemic infection.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

Assessment of HCV treatment response. Nucleic acid testing for qualitative or quantitative detection of HCV RNA should be used as test of cure at 12 or 24 weeks (i.e. sustained virological response (SVR12 or SVR24)) after completion of antiviral treatment

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Moderate

Point-of-care (POC) HCV RNA assays with comparable limit of detection to laboratory-based assays can be used as an alternative approach as test of cure.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

Reflex HCV RNA viral load testing. We recommend reflex HCV RNA testing in those with a positive HCV antibody test result as an additional key strategy to promote linkage to care and treatment. This can be achieved either through laboratory-based reflex HCV RNA testing following a positive HCV antibody test using a specimen already held in the laboratory, or clinic-based reflex testing in a health facility through immediate specimen collection following a positive HCV antibody RDT

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

We recommend treatment using pangenotypic direct-acting antiviral (DAA) regimens for all adults with chronic hepatitis C infection, regardless of stage of disease

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

We recommend treatment using pangenotypic DAA regimens for all adolescents (12–17 years) with chronic hepatitis C infection, regardless of stage of disease

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

We recommend treatment using pangenotypic DAA regimens for all children ages 6–11 years with chronic hepatitis C infection, regardless of stage of disease

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

We recommend treatment using pangenotypic DAA regimens for all children ages 3–5 years years with chronic hepatitis C infection, regardless of stage of disease

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

We recommend the use of the following pangenotypic DAA regimens in adults (18 years and above) with chronic hepatitis C infection, regardless of stage of disease: sofosbuvir/daclatasvir (Most widely used regimen in adults due to availability of quality-assured, low-cost generics) for 12 weeks (In those without cirrhosis. Treatment for 24 weeks in those who are treatment-experienced or with compensated cirrhosis), sofosbuvir/velpatasvir for 12 weeks, glecaprevir/pibrentasvir for eight weeks

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

We recommend the use of the following pangenotypic DAA regimens in adolescents (12–17 years) with chronic hepatitis C infection, regardless of stage of disease: sofosbuvir/daclatasvir (Most widely used regimen in adults due to availability of quality-assured, low-cost generics) for 12 weeks (In those without cirrhosis. Treatment for 24 weeks in those who are treatment-experienced or with compensated cirrhosis)

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

We recommend the use of the following pangenotypic DAA regimens in adolescents (12–17 years) with chronic hepatitis C infection, regardless of stage of disease: sofosbuvir/velpatasvir for 12 weeks

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

We recommend the use of the following pangenotypic DAA regimens in adolescents (12–17 years) with chronic hepatitis C infection, regardless of stage of disease: glecaprevir/pibrentasvir for eight weeks

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

We recommend the use of the following pangenotypic DAA regimens in older children (6–11 years) with chronic hepatitis C infection, regardless of stage of disease: sofosbuvir/daclatasvir (Most widely used regimen in adults due to availability of quality-assured, low-cost generics) for 12 weeks (In those without cirrhosis. Treatment for 24 weeks in those who are treatment-experienced or with compensated cirrhosis)

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

We recommend the use of the following pangenotypic DAA regimens in older children (6–11 years) with chronic hepatitis C infection, regardless of stage of disease: sofosbuvir/velpatasvir for 12 weeks

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

We recommend the use of the following pangenotypic DAA regimens in older children (6–11 years) with chronic hepatitis C infection, regardless of stage of disease: glecaprevir/pibrentasvir for eight weeks

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

We recommend the use of the following pangenotypic DAA regimens in younger children (3–5 years) with chronic hepatitis C infection, regardless of stage of disease: sofosbuvir/daclatasvir (Most widely used regimen in adults due to availability of quality-assured, low-cost generics) for 12 weeks (In those without cirrhosis. Treatment for 24 weeks in those who are treatment-experienced or with compensated cirrhosis), sofosbuvir/velpatasvir for 12 weeks, glecaprevir/pibrentasvir for eight weeks

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low