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Page 3 of 17

Screening and Testing Table 1. Interpretation of HCV Assays Anti-HCV HCV RNA Positive Interpretation Positive Negative Positive Negative Positive Negative Negative Acute or chronic HCV depending on the clinical context Resolution of HCV; acute HCV during period of low-level viremia Early acute HCV infection; chronic HCV in setting of immunosuppressed state; false positive HCV RNA test Absence of HCV infection Liver Biopsy ÎThere are three primary reasons for performing a liver biopsy: 1. It provides helpful information on the current status of the liver injury. 2. It identifies features useful in the decision to embark on therapy. 3. It may reveal advanced fibrosis or cirrhosis that necessitates surveillance for hepatocellular carcinoma (HCC) and/or screening for varices. ÎA liver biopsy should be considered in patients with CHC infection if the patient and health care provider wish information regarding fibrosis stage for prognostic purposes or to make a decision regarding treatment (IIa-B). ÎCurrently available noninvasive tests may be useful in defining the presence or absence of advanced fibrosis in persons with CHC infection, but should practice (IIb-C). Selecting a Treatment Regimen Chronic ÎTreatment decisions should be individualized based on the severity of liver disease, the potential for serious side effects, the likelihood of treatment response, the presence of comorbid conditions, and the patient's readiness for treatment (IIa-C). ÎFor patients in whom liver histology is available, treatment is indicated in those with bridging fibrosis or compensated cirrhosis provided they do not have contraindications to therapy (I-B). ÎHCV RNA should be tested by a highly sensitive quantitative assay at the initiation of or shortly before treatment and at weeks 4, 8 & 12 of therapy (I-A). replace the liver biopsy in routine clinical 2 N OT

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