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AASLD Hepatitis C Guidelines

The American Association for the Study of Liver Diseases (AASLD) publishes guidelines for the diagnosis and treatment of liver diseases, including hepatitis at least once every year in order to provide diagnosticians and medical practitioners with the most recent information. The guidelines for hepatitis C were last updated in April 2009 and were written by Marc G. Ghany, MD, Doris B. Strader, VT, David L. Thomas, MD, and Leonard B. Seeff, MD.

  1. Testing

    • The AASLD recommends that all people who currently use or who have used injection drugs should be tested for hepatitis C. Other risk groups include people who received an organ, blood or blood product donation before 1992, hemophiliacs who received blood product donations before 1987, people with an unexplained high level the enzyme aminotransferase, people who have had hemodialysis, the offspring of mothers with hepatitis C and people with HIV. The sex partners of people with hepatitis C should be tested, although sexual transmission of the infection is not common.

    Diagnosis

    • The AASLD recommends the use of tests that show antibodies to the hepatitis C virus (HCV) as well as tests that detect the virus' RNA to confirm an infection. Patients should first be tested for antibodies, which can show whether or not they have ever been infected with HCV, but does not necessarily indicate current infection. Those individuals who test positive for HCV antibodies should then be tested for the presence of HCV viral RNA, which does indicate the presence of an active infection. RNA testing is also recommended for patients who do not show antibodies but who have a weakened immune system and who may have recently contracted HCV. The AASLD also recommends genotype testing; this shows which type of the virus has been contracted and allows doctors to make better treatment decisions.

    Liver Testing

    • To discover the progress of liver disease in people with chronic HCV infection, the AASLD recommends the use of liver biopsy. This is especially true for people with HCV genotype 1 infection, who do not respond as well to people with genotypes 2 and 3 to antiviral treatment.

    Treatment

    • The AASLD's recommended treatment for chronic HCV infection is a combination of the antiviral drugs peginterferon alfa and ribavirin. People with genotype 1 generally need to be treated with antivirals for 48 weeks, while those with types 2 and 3 need only be treated for 24 weeks. People undergoing treatment for HCV infection should be tested throughout the course of treatment to see if the virus has been cleared. If this occurs before the treatment is completed, the doctor may recommend that treatment be stopped.

    Considerations

    • Some people do not respond positively to antiviral treatment for HCV infection. The AASLD does not recommend continuing antiviral treatment in these patients unless they were treated with non-pegylated interferon or pegylated interferon alone during the first course of treatment.

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