A guideline published in the June 4 issue of CMAJ, the journal of the Canadian Medical Association, provides updated evidence-based recommendations for the treatment of patients with chronic hepatitis C virus (HCV) infection.

Hemant Shah, M.D., from the University of Toronto, and colleagues conducted a focused literature search to update the evidence base used in the 2015 guideline. The resulting guideline was developed to assist physicians and other health care professionals in the management of adult patients with chronic HCV infection.

The Canadian Association for the Study of the Liver recommends the following: birth cohort screening for individuals born from 1945 to 1975; a pretreatment evaluation of infected patients that includes clinical evaluation, viral load, genotype, and a fibrosis stage assessment; the use of all-oral regimens for all infected patients, not interferon-based treatment regimens; the individualization of treatment, particularly for difficult-to-cure populations; and life-long surveillance for the development of hepatocellular cancer among patients with cirrhosis.

"In the coming years, the major challenge of HCV management will not be treatment, but rather prevention, screening and linkage to care," write the authors. "Although many novel models of care have been developed, the optimal strategies, particularly to reach vulnerable populations, are not clear and must be a major research priority."

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