Historically, guidelines for most clinical diseases have been published in print journals. This meant that a significant delay, often up to 3 or more years, between the decision to publish a new set of Guidelines to their publication owing to an onerous process. This included the time it took to gather the experts together, convene a series of meetings of the panel, have deliberations, reach consensus, write up and publish their recommendations. Sometimes delays were such that by the time that the Guidelines got into print, they were at risk of being outdated.
In the case of hepatitis C, with the revolution of the direct-acting antivirals (DAAs), the traditional process for creating guidelines were recognized as being inadequate to accommodate the rapidly changing field and make the guidelines accurate, current, and relevant. As such, the AASLD along with the IDSA embarked upon a novel and transformative approach to hepatitis C guidelines. Namely, they published the guidelines online in a web-based format that allows rapid updates and provides tremendous flexibility for the end user in terms of accessing information in just a click or two on their computer or device.
The first iteration of the guidelines appeared online in 2014 and has been widely applauded as meeting both the needs of clinicians in practice as well as assuring that what is online is accurate and up to date. Since the original publication of the guidelines online, they have been updated at least a dozen times, with major revisions in conjunction with the release of a new medication for the treatment of hepatitis C.
With the latest update of the Guidelines in September 2017, the guidelines are relatively complete. Most of the drugs previously in development are now approved and fewer drugs are currently in development. The guidelines have been helped by the release of pan genotypic DAA regimens, often in the form of just a few tablets once a day for 8 to 12 weeks that are associated with greater than 97% cure. The notion of pan-genotypic regimens simplifies the complexity of treating hepatitis C, making it even more accessible to non-hepatologists including gastroenterologists, infectious disease specialists, and primary care providers who can treat patients in routine practice without necessarily having to refer to a liver specialist.
Another benefit of the guidelines is the background sections on assessment and staging of liver disease prior to treatment along with readily accessed key references that provide support for the recommendations.
The HCV guidelines, which are accessed at www.hcvguidelines.org, are a tremendous resource for any clinician in practice who wants the most current information on treating hepatitis C at their fingertips. My hope is that other guidelines, such as hepatitis B treatment guidelines and several others in the realm of infectious disease will adopt similar online approaches where the guidelines are both accessible and easily updated as new developments occur.
- AASLD-IDSA. Recommendations for testing, managing, and treating hepatitis C. http://www.hcvguidelines.org. Accessed January 25, 2018.
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- Michael S. Saag, MD, can be reached at email@example.com.
Disclosure: Saag reports receiving research support and acting as a scientific advisor to Bristol-Myers Squibb, Gilead, Merck and ViiV.