Proportion of patients treated outside of clinical trials for non-genotype 1 who receive therapy with pegylated interferon and ribavirin Proportion of patients treated for non-genotype 1 with a Metavir score of F4 who are offered treatment with pegylated interferon and ribavirin unless contraindicated Proportion of patients with non-genotype 1–4 referred to a tertiary centre Proportion of patients not receiving therapy undergoing repeat non-invasive staging of their liver disease within 1 year The response rate of genotype 4 HCV monoinfection to a PEG-IF/RBV regimen is similar to that seen with genotype

1, with a figure ranging between 43–50% being observed in clinical trials. As with genotypes 2 and 3, neither of the two currently available HCV protease inhibitors has SB431542 research buy been studied, but the newer anti-HCV agents are being studied across all genotypes with excellent

initial responses in monoinfected patients [101]. Due to the low rates of success with pegylated Y-27632 molecular weight interferon and ribavirin we suggest that treatment is deferred where possible and treatment with newer agents within clinical trials actively sought. Where the individual has liver disease staging suggestive of Metavir stage 4, a complication of disease, or it is the informed wish of the patient to commence therapy, then treatment is recommended. This should be with pegylated interferon and ribavirin. The duration of therapy should be 48 weeks if an undetectable HCV RNA is achieved at 4 weeks, with a consideration to extend this to 72 weeks if achieved by 12 weeks. If the RNA is still detectable at 12 weeks, consideration should be given to discontinuing treatment. All individuals deferring therapy should undergo hepatic elastography or an alternative non-invasive test at least annually. Individuals infected with genotypes other than 1–4 should be referred to a centre with experience of treating HCV infection with these genotypes for a treatment

plan to be made in consultation with the host centre. We recommend patients without a decrease Oxymatrine of 2 log10 in HCV RNA at week 4 post diagnosis of acute infection (1D) or with a positive HCV RNA week 12 post diagnosis of acute infection (1C) are offered therapy. We recommend therapy be commenced prior to an estimated duration of infection of 24 weeks (1D). Patients who have not commenced treatment by this time should be managed as for chronic hepatitis C. We recommend all patients be offered combination therapy with pegylated interferon and weight-based ribavirin (1C). We recommend against treatment with PEG-IFN monotherapy (1C). We recommend treatment is discontinued if patients do not achieve an EVR (1C). We recommend patients with re-emergent virus after spontaneous or therapeutic clearance are assessed for relapse or reinfection (1C). We recommend patients with AHC who relapse are managed as for chronic hepatitis C (1D).