Table 1 | Table 2 | Table 3 | Table 4 | Table 5 | Table 6 | Table 7 | Table 8 | Table 9 | Table 10 | Table 11 | Table 12 | Table 13 | Table 14 | Table 15
Table 1. Summary of Guidance Committee Recommendations on Managing HCV Infection in PWID[AASLD-IDSA HCV; EASL HCV]
| Care Component | AASLD/IDSA | EASL |
| Screening | - Screen for HCV annually in PWID with no previous testing and in PWID with IDU following negative test
- Consider increasing HCV screening frequency according to level of risk
- Needle exchange programs and substance use disorder treatment programs: Offer routine, opt-out HCV antibody testing with reflexive/immediate confirmatory HCV RNA testing and linkage to care
| - Provide voluntary, routine testing for anti-HCV antibodies and HCV RNA in PWID
- Test HCV RNA annually and after any high-risk injecting episode in HCV RNA–negative PWID
|
| Counseling | - Counsel on strategies to reduce risk of transmitting HCV
| - Address HCV transmission, risk factors for fibrosis progression, treatment, risk for reinfection, and strategies for harm reduction during pretherapeutic education
|
| Harm reduction | - Offer linkage to available harm-reduction services (ie, needle exchange programs, substance use disorder treatment programs)
- Prescribe naloxone to all PWID
| - Provide appropriate access to OST plus clean drug injecting equipment as part of harm-reduction programs (including in prisons)
|
| HCV treatment | - Active/recent drug use or concerns about reinfection are not contraindications to HCV treatment
| - All PWIDs with HCV infection have indication for antiviral treatment
- For patients receiving medication treatment for opioid use disorder, DAA therapies do not require methadone or buprenorphine dose adjustment
- Offer HCV treatment to all incarcerated patients with HCV infection
- HCV treatment should be scaled- up in PWIDs to increase likelihood of achieving HCV elimination goals, including treatment as prevention
|
| Follow-up After SVR | - Test HCV RNA at least annually in PWID with recent IDU who have been successfully treated or spontaneously cleared HCV infection
| - Reduce risk of HCV reinfection by providing harm reduction, education, and counseling in setting of HCV treatment
- Test HCV RNA at least annually (preferably biannually) in PWID with ongoing risk behavior
- Provide retreatment if reinfection identified
|
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