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Position Paper on Treatment of Hepatitis C in Romania 2017. Part Two

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Liana Gheorghe1, Ioan Sporea2, Speranța Iacob1, Roxana Șirli2, Anca Trifan3, Mircea Diculescu1, Carol Stanciu3, Oliviu Pascu4, Monica Acalovschi4, Ciprian Brisc5, Cristina Cijevschi3, Cristian Gheorghe1, Zeno Spârchez4, Ion Rogoveanu6, Daniela Dobru7, Dan L. Dumitrascu8

1) Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest;
2) Department of Gastroenterology and Hepatology, Victor Babeș University of Medicine and Pharmacy, Timișoara; 3) Institute of Gastroenterology and Hepatology, Grigore T. Popa University of Medicine and Pharmacy, Iasi;
4) 3rd Medical Clinic, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca;
5) Gastroenterology Department, Faculty of Medicine and Pharmacy, Oradea;
6) Gastroenterology Department, University of Medicine and Pharmacy, Craiova;
7) Gastroenterology Department, University of Medicine and Pharmacy, Târgu Mureș;
8) 2nd Medical Clinic, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.263.rom

ABSTRACT
Background & Aims: Hepatitis C virus (HCV) infection is a common condition with endemic prevalence in some areas of the world. In Romania, the mean prevalence is about 3%. New treatments have become available on the market in recent years and new drugs are in the pipeline. A re-evaluation of HCV therapy was considered mandatory. The Romanian Society of Gastroenterology and Hepatology undertook this task for the practitioners of this country.
Methodology: A group of recognized experts was created who screened the available literature and the major available guidelines. A list of items requiring attention was created and these were discussed and rated. Decisions were taken by consensus.
Recommendations: We present here the second part of the Society’s recommendations for chronic HCV infection treatment. An agreement between experts was reached regarding the therapy of the special categories of patients infected with HCV, complications and monitoring of the therapy, follow-up of the patients who reached sustained virologic response and re-treatment of the patients with therapy failure.
Conclusions: This Position Paper represents a guide for the assessment and the therapy of HCV infection. The recommendations are in concordance with other guidelines but are applied to real-life conditions in Romania.
Key words: Hepatitis C Virus – Guideline – Diagnosis – Treatment – Direct Antiviral Agents – National Strategy – Viral hepatitis C.
Abbreviations: CKD: Chronic kidney disease; DAAs: Direct-acting antivirals; DDIs: Drug-drug interactions; ESDL: End-stage liver disease; FCH: Fibrosing cholestatic hepatitis; GT: Genotype; HCV: Hepatitis C virus; HCC: Hepatocellular carcinoma; LT: Liver transplantation; MELD score: Mayo-Clinic End-Stage Liver Disease score; PDC: Premature discontinuation; PWID: Persons who inject drugs; RASs: Resistance associated substitutions; RBV: Ribavirin; RCT: Randomized controlled trial; SAE: Serious adverse events; SRGH: Romanian Society of Gastroenterology and Hepatology; SVR: Sustained virologic response.