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Dig Liver Dis. 2016 Sep;48(9):995-1005. doi: 10.1016/j.dld.2016.06.004. Epub 2016 Jun 15.

From current status to optimization of HCV treatment: Recommendations from an expert panel.

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Department of Gastroenterology, DiBiMIS, University of Palermo, Palermo, Italy.
Virology Unit, Department of Experimental Medicine and Surgery, "Tor Vergata" University of Rome, Rome, Italy.
Hepatology Unit, Ospedale San Giuseppe, University of Milan, Milan, Italy.
Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
Department of Molecular Medicine, University of Padova, Padova, Italy.
Department of Medical and Surgical Sciences, Bologna University, Bologna, Italy.
Department of Medical and Surgical Sciences, Bologna University, Bologna, Italy; Department of Infectious Diseases, University of Rome Tor Vergata, Rome, Italy.
Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy.
Hepatology Unit, University Hospital of Pisa, Pisa, Italy.
Department of Internal Medicine, Humanitas University Medicine, Rozzano, Italy.
Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Naples "Federico II", Naples, Italy.
III U.O.C. P.O. Cotugno AORN Ospedali dei Colli, Naples, Italy.
Department of Gastroenterology and Hepatology, Città della Salute e della Scienza Hospital and Department of Medical Sciences, University of Turin, Turin, Italy.
Department of Gastroenterology, Hepatology and Liver Transplantation, Papa Giovanni XXIII Hospital, Bergamo, Italy.
Unit of Infectious Diseases and Hepatology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
Section of Infectious Diseases, Department of Internal Medicine, Second University aof Naples, Naples, Italy.
Liver Unit, San Camillo Forlanini Hospital, Rome, Italy.
Division of Infectious Diseases, AO Ospedale Niguarda Ca' Granda, Milan, Italy.
Division of Clinical and Molecular Hepatology, Department of Internal Medicine, University Hospital of Messina, Messina, Italy.
Infectious and Tropical Diseases Unit, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.
Division of Gastroenterology, A.O.U. Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy.
Center for Systemic Manifestations of Hepatitis Viruses (MASVE), Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.


Chronic hepatitis C virus (HCV) infection is a major public health problem at a global level, causing an enormous burden of hepatic and extra-hepatic morbidity and mortality. Treatment of chronic HCV (CHC) has been revolutionized in the last few years by the introduction of highly effective and well tolerated direct acting antiviral agents (DAAs) able to achieve >90% rates of sustained virological response (SVR) in many groups of patients, including those previously excluded from interferon-based regimens. For such reason interferon-free regimens are now the treatments of choice for all patients. Successful anti-HCV treatment can stop liver disease progression and can solve the HCV-related extra hepatic manifestations, eventually reducing both liver-related and overall mortality. Together with the rapidly accumulating data about the evolution of treatment landscape, different guidelines from national and international Liver Scientific Societies have been published until today. However, these recommendations may not be applied worldwide as, due to high treatment costs, most of them identify as priority groups only patients with advanced liver disease. Moreover some types of patients pose clinical management problems for which even the guidelines do not always provide useful answers. With the aim of treatment optimization by filling some of the gaps of the current guidelines and addressing the remaining unmet needs in practice, a group of Italian experts, experienced on treatment of HCV infection, met in Stresa in February 2016. The summary of all the considerations arising from this two-day meeting and the final statements are reported in this position paper.


Antiviral therapy; Cirrhosis; Direct-acting antiviral agents; HCV; Hepatitis C; Liver transplantation; Resistance

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