- The Italian Association for the Study of the Liver (AISF) has issued recommendations on HCV in immunocompromised patients.
Oncology, rheumatic diseases, IBD
- All patients with solid cancer and chemotherapy candidates, those with rheumatic diseases, and others requiring immunosuppressive therapy should be screened for HCV and treated with direct-acting antivirals (DAAs).
Hemopoietic cells transplant (HCT)
- DAAs should be offered first-line to HCV-RNA+ patients with indolent B-cell non-Hodgkin lymphoma who are not candidates for immediate immunotherapy.
- DAA therapy can be concomitant or delayed in patients eligible for immune-chemotherapy (ICT) for lymphoma.
- HCV-RNA+ patients should be monitored during chemotherapy/ICT through viral clearance and during hepatitis flare; further surveillance suggested post-immunosuppression.
Liver transplant (LT)
- Hepatocellular carcinoma (HCC) + compensated cirrhosis: treat if LT waitlist time >3 months.
- Decompensated cirrhosis ± HCC: treated if model for end-stage liver disease (MELD) score ≤20.
- Decompensated cirrhosis ± HCC and MELD ≥30: high LT priority; use DAAs after LT.
- Note: a 30-day period of virologic suppression is needed to prevent post-LT recurrence; if this cannot be achieved, DAAs should be resumed post-LT.
- Resistance testing is indicated if treatment fails.
Solid organ transplant
- HCV+ organs should be reserved for HCV+ recipients in the absence of approved study protocols.