November 22, 2013

New in January 2014: Clinical Guidance for Hepatitis C

The AASLD/IDSA Clinical Guidance for Hepatitis C

Background
AASLD and the Infectious Diseases Society of America (IDSA) have initiated a joint-society effort to establish a consensus and dynamic HCV guideline and will partner with the International Antiviral Society-USA (IAS-USA) in this effort. IAS-USA is a not-for-profit educational organization that has provided state-of-the-art, balanced CME and published respected clinical guidelines for two decades. IAS-USA will provide structure (project management) and coordination as well as web development for the recommendations and their dissemination. Representatives from other societies with an interest in hepatitis C management (e.g. AGA, CDC) may designate a liaison already within the writing groups, with the approval of the chairs and vetting group.

The guidelines will be updated in a timely manner as developments in the field evolve rapidly over the next several years. Although the guideline will be published in HEPATOLOGY and Clinical Infectious Diseases in alternate years, frequent updates will appear online and be announced in the AASLD eNews. The target for the first edition of the guideline is January 2014.

Five chairs (two AASLD, two IDSA, and one IAS-USA) have been appointed from each society for a term of three to five years; one of whom from each society has no conflicts of interest.

AASLD: Donald Jensen, MD and Gary Davis, MD  
IDSA: David Thomas, MD and Henry Masur, MD  
IAS-USA: Michael Saag, MD     

The chairs will oversee the entire process of recommendation development and offer leadership in maintaining effective timelines and scientific credibility. The writing group is comprised of ten members each from AASLD and IDSA who are recognized as experienced experts in the field. The Institute of Medicine recommendation that at least 51 percent of writing group members be “non-conflicted” was adopted in principle. The GRADE system, commonly used for guideline development, was not felt to be suitable in this case as it would likely slow down the process in the rapidly evolving field and would delay the provision of timely and urgently needed guidance. Rather, the AASLD rating system used in the updated hepatitis C guideline published in 2011 will be used as the rating system for the quality of the evidence and strength of the recommendations.

Both the AASLD Governing Board and the IDSA Board of Directors have stated a commitment to generously fund this endeavor for three years, with terms for renewal as needed. This commitment will provide the necessary resources for the representatives of the respective societies to succeed in performing this important work and providing effective clinical guidance to clinicians who treat HCV.

Summary

The development of comprehensive HCV practice recommendations from two lead societies who are both highly regarded will be an important step in patient care management as numerous new therapeutic options become available. The web-based system, which has previously been so successful in HIV guidance, will ensure that the recommendations are both rapid and nimble to these changes. This system should prove to be highly valuable to providers, payers, and industry.

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