Summary: When and in Whom to Initiate HCV Therapy
Goal of Treatment
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RECOMMENDED
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RATING 
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The goal of treatment of HCV-infected persons is to reduce all-cause mortality and liver-related health adverse consequences, including end-stage liver disease and hepatocellular carcinoma, by the achievement of virologic cure as evidenced by a sustained virologic response.
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I, A
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Recommendation for When and in Whom to Initiate Treatment
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RECOMMENDED
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RATING
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Treatment is recommended for all patients with acute or chronic HCV infection, except those with a short life expectancy that cannot be remediated by HCV therapy, liver transplantation, or another directed therapy. Patients with a short life expectancy owing to liver disease should be managed in consultation with an expert.
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I, A
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Pretreatment Assessment
Recommendation for Pretreatment Assessment
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RECOMMENDED
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RATING
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Evaluation for advanced fibrosis using noninvasive markers and/or elastography, and rarely liver biopsy, is recommended for all persons with HCV infection to facilitate decision making regarding HCV treatment strategy and determine the need for initiating additional measures for the management of cirrhosis (eg, hepatocellular carcinoma screening) (see HCV Testing and Linkage to Care).
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I, A
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Recommendation for Repeat Liver Disease Assessment
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RECOMMENDED
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RATING
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Ongoing assessment of liver disease is recommended for persons in whom therapy is deferred.
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I, C
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