Page 14 - EASL Recommendations on Treatment of Hepatitis C 2015 - Summary
P. 14
• Sofosbuvir should not be administered to patients with • HCV treatment for PWIDs should be considered
an eGFR <30 ml/min/1.73 m2 or with end-stage renal on an individualized basis and delivered within a
disease until more data is available (B2) multidisciplinary team setting (A1)
• The need for dose adjustments for the approved HCV • Pre-therapeutic assessment should include an evaluation
DAAs in patients on dialysis is unknown. No safety of housing, education, cultural issues, social functioning
dosing and efficacy data is available in this population. and support, finances, nutrition and drug and alcohol
These drugs should thus be used with extreme caution use. PWIDs should be linked into social support services
in patients with severe renal disease, and only in and peer support, if available (A1)
extreme life-threatening situations for patients on
dialysis (B1) • A history of intravenous drug use and recent drug use at
treatment initiation are not associated with reduced SVR
Non-hepatic solid organ transplant and decisions to treat must be made on a case-by-case
recipients basis (B1)
• HCV treatment before kidney transplantation may avoid • Drug and alcohol users or any other patients with on-
liver-related mortality in the post-transplant patient, going social issues and/or history of psychiatric disease,
and may prevent HCV-specific causes of renal graft and those with more frequent drug use during therapy,
dysfunction. Where possible, antiviral therapy should are at risk of lower adherence and reduced likelihood of
be given to potential transplant recipients before listing achieving SVR. They need to be monitored more closely
for renal transplantation. These patients should receive during therapy and need more intensive multidisciplinary
an IFN-free, if possible ribavirin-free regimen, for 12 support (B1)
weeks in patients without cirrhosis, for 24 weeks in
patients with compensated (Child-Pugh A) cirrhosis, • Evaluation of safety and efficacy of new IFN-containing
following the above recommendations. However, no and IFN-free regimens in PWIDs is needed (C1)
safety and efficacy data is available in this population,
and the need for dose adjustments for the new • PWIDs on opioid substitution therapy should receive an
DAAs is unknown. These drugs should thus be used IFN-free regimen (B1)
with extreme caution and sofosbuvir should not be
administered to patients with an eGFR <30 ml/min/1.73 • The anti-HCV regimens that can be used in PWIDs are
m2 or with end-stage renal disease until more data is the same as in non-PWIDs. They do not require specific
available (B1) methadone and buprenorphine dose adjustment, but
monitoring for signs of opioid toxicity or withdrawal
• In non-hepatic solid organ transplant recipients, should be undertaken. More data is needed with
patients with an indication for anti-HCV therapy daclatasvir (B1)
should receive an IFN-free regimen, following the
above recommendations on treatment regimen and • Awareness should be raised that liver transplantation is
management of drug-drug interactions with cyclosporine a therapeutic option in those with a history of intravenous
and tacrolimus when appropriate (B2) drug use (B1)
Active drug addicts and patients on stable • Opioid substitution therapy is not a contra-indication for
maintenance substitution liver transplantation and individuals on opioid substitution
should not be advised to reduce or stop therapy (B1)
• PWIDs should be routinely and voluntarily tested for HCV
antibodies and if negative, every 6-12 months (B1) Haemoglobinopathies
• PWIDs should be provided with clean drug injecting • The indications for HCV therapy are the same in
equipment and access to opioid substitution therapy patients with and without haemoglobinopathies (A1)
as part of widespread comprehensive harm reduction
programs, including in prisons (B1) • Patients with haemoglobinopathies should be treated
with an IFN-free regimen, without ribavirin (B1)
• Pre-therapeutic education should include discussions of
HCV transmission, risk factors for fibrosis progression, • The anti-HCV regimens that can be used in patients
treatment, reinfection risk, and harm reduction strategies with haemoglobinopathies are the same as in patients
(B1) without haemoglobinopathies (B1)
• PWIDs should be counselled to moderate alcohol intake, • When the use of ribavirin is needed, careful monitoring
or to abstain if there is evidence of advanced liver is recommended, and blood transfusions may be
disease (A1) required (B2)
• PWIDs should be counselled to moderate cannabis Bleeding disorders
use, or to abstain if there is evidence of advanced liver
disease (B2) • The indications for HCV therapy are the same in
patients with and without bleeding disorders (A1)
• HCV treatment for PWIDs should be considered
on an individualized basis and delivered within a • Potential drug-drug interactions in HCV-HIV coinfected
multidisciplinary team setting (A1) patients receiving antiretroviral agents requires careful
selection of agents (A1)
• Pre-therapeutic assessment should include an evaluation
13 of housing, education, cultural issues, social functioning
and support, finances, nutrition and drug and alcohol
use. PWIDs should be linked into social support services
an eGFR <30 ml/min/1.73 m2 or with end-stage renal on an individualized basis and delivered within a
disease until more data is available (B2) multidisciplinary team setting (A1)
• The need for dose adjustments for the approved HCV • Pre-therapeutic assessment should include an evaluation
DAAs in patients on dialysis is unknown. No safety of housing, education, cultural issues, social functioning
dosing and efficacy data is available in this population. and support, finances, nutrition and drug and alcohol
These drugs should thus be used with extreme caution use. PWIDs should be linked into social support services
in patients with severe renal disease, and only in and peer support, if available (A1)
extreme life-threatening situations for patients on
dialysis (B1) • A history of intravenous drug use and recent drug use at
treatment initiation are not associated with reduced SVR
Non-hepatic solid organ transplant and decisions to treat must be made on a case-by-case
recipients basis (B1)
• HCV treatment before kidney transplantation may avoid • Drug and alcohol users or any other patients with on-
liver-related mortality in the post-transplant patient, going social issues and/or history of psychiatric disease,
and may prevent HCV-specific causes of renal graft and those with more frequent drug use during therapy,
dysfunction. Where possible, antiviral therapy should are at risk of lower adherence and reduced likelihood of
be given to potential transplant recipients before listing achieving SVR. They need to be monitored more closely
for renal transplantation. These patients should receive during therapy and need more intensive multidisciplinary
an IFN-free, if possible ribavirin-free regimen, for 12 support (B1)
weeks in patients without cirrhosis, for 24 weeks in
patients with compensated (Child-Pugh A) cirrhosis, • Evaluation of safety and efficacy of new IFN-containing
following the above recommendations. However, no and IFN-free regimens in PWIDs is needed (C1)
safety and efficacy data is available in this population,
and the need for dose adjustments for the new • PWIDs on opioid substitution therapy should receive an
DAAs is unknown. These drugs should thus be used IFN-free regimen (B1)
with extreme caution and sofosbuvir should not be
administered to patients with an eGFR <30 ml/min/1.73 • The anti-HCV regimens that can be used in PWIDs are
m2 or with end-stage renal disease until more data is the same as in non-PWIDs. They do not require specific
available (B1) methadone and buprenorphine dose adjustment, but
monitoring for signs of opioid toxicity or withdrawal
• In non-hepatic solid organ transplant recipients, should be undertaken. More data is needed with
patients with an indication for anti-HCV therapy daclatasvir (B1)
should receive an IFN-free regimen, following the
above recommendations on treatment regimen and • Awareness should be raised that liver transplantation is
management of drug-drug interactions with cyclosporine a therapeutic option in those with a history of intravenous
and tacrolimus when appropriate (B2) drug use (B1)
Active drug addicts and patients on stable • Opioid substitution therapy is not a contra-indication for
maintenance substitution liver transplantation and individuals on opioid substitution
should not be advised to reduce or stop therapy (B1)
• PWIDs should be routinely and voluntarily tested for HCV
antibodies and if negative, every 6-12 months (B1) Haemoglobinopathies
• PWIDs should be provided with clean drug injecting • The indications for HCV therapy are the same in
equipment and access to opioid substitution therapy patients with and without haemoglobinopathies (A1)
as part of widespread comprehensive harm reduction
programs, including in prisons (B1) • Patients with haemoglobinopathies should be treated
with an IFN-free regimen, without ribavirin (B1)
• Pre-therapeutic education should include discussions of
HCV transmission, risk factors for fibrosis progression, • The anti-HCV regimens that can be used in patients
treatment, reinfection risk, and harm reduction strategies with haemoglobinopathies are the same as in patients
(B1) without haemoglobinopathies (B1)
• PWIDs should be counselled to moderate alcohol intake, • When the use of ribavirin is needed, careful monitoring
or to abstain if there is evidence of advanced liver is recommended, and blood transfusions may be
disease (A1) required (B2)
• PWIDs should be counselled to moderate cannabis Bleeding disorders
use, or to abstain if there is evidence of advanced liver
disease (B2) • The indications for HCV therapy are the same in
patients with and without bleeding disorders (A1)
• HCV treatment for PWIDs should be considered
on an individualized basis and delivered within a • Potential drug-drug interactions in HCV-HIV coinfected
multidisciplinary team setting (A1) patients receiving antiretroviral agents requires careful
selection of agents (A1)
• Pre-therapeutic assessment should include an evaluation
13 of housing, education, cultural issues, social functioning
and support, finances, nutrition and drug and alcohol
use. PWIDs should be linked into social support services
