AISF issues position paper on HCV in immunocompromised patients

  • Italian Association For The Study Of The Liver Aisf
  • Dig Liver Dis
  • 1 Oct 2018

  • from Yael Waknine
  • HCV Clinical Digest
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Takeaway

  • 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.