South African Hepatitis C Management Guidelines 2010 : guidelines

The hepatitis C virus (HCV) is a global public health problem and a leading cause of chronic liver disease and the past decade has seen several significant advances in the management of persons infected with the virus. The prevalence of HCV infection in South Africa is not known but has been estimated to be between 0.1 and 1.7 %. Phylogenetic analysis of the HCV has revealed 6 main genotypes and most published data relate to genotypes 1, 2 and 3. Genotypes 4, 5 and 6 however represent > 20 % of HCV infections worldwide. Genotype 5 is found predominantly in South Africa where it represents up to 40 % of all HCV genotypes. Chronic hepatitis C is an important cause of end stage liver disease and individuals with HCV-related cirrhosis have a 30 % risk of developing hepatic decompensation in 10 years and a 1 - 3 % per annum risk of developing hepatocellular carcinoma (HCC). Male gender, infection at an advanced age, obesity, consumption of > 50 g alcohol per day and co-infection with the human immunodeficiency virus (HIV) are predictive of more rapid progression to fibrosis. This document is based largely on the American Association for the Study of Liver Diseases (AASLD) 2009 Practice Guidelines and aims to provide clinicians with evidence based approaches to the management of HCV infection. It is recognized that reasonable physicians may deviate from the strategy and remain within acceptable standards of treatment.