Vito Di Marco – Biomedic department of specialistic and internal medicine – gastroenterology and epatology section – Palermo University, Italia
Aims: To optimize management of chronic HCV hepatitis, a Delphi method was used to facilitate
the consensus of experts in situations where the quality of evidence is variable and there is a lack
of clear recommendations to guide real-life clinical practice.
Methods: An Advisory Board agreed two questionnaires on epidemiological, diagnostic and therapeutic
choices. Questionnaires were administered in two rounds to an Expert Panel (EP).
Results: In total 443 physicians working in 235 Italian HCV referral centres replied to the
questionnaires. The EP did not agree on the prevalence of HCV infection in Italy and on
treating patients over 80 years with DAAs. They agreed on collaboration with GPs and
HCV testing in high-risk groups to increase access to DAAs. Over 90% agreed with quantifying
HCV-RNA, determining genotype, and testing for anti-HIV and HBsAg before DAAs.
Over 90% used transient elastography (FibroScan®) to evaluate the stage of liver fibrosis and
serum biomarkers were used by less than 20%. Ease of adherence to therapy, lack of drugdrug
interactions and the possibility of treating advanced liver disease were decisive factors
in therapy choice. Addition of ribavirin and time of therapy were less determining factors.
Monthly monitoring during therapy was considered appropriate and 80% were in favour of
HCV-RNA testing 24 weeks after the end of the therapy to confirm SVR. Over 80% agreed
with the need to continue follow-up of patients with advanced fibrosis/cirrhosis.
Conclusion: The expert panel did not completely agree on all procedures in managing patients
with HCV chronic hepatitis. Scientific organizations should review some recommendations
in their guidelines to facilitate access of patients to DAAs, increase centre capacity
and simplify follow-up post therapy.
Parole chiave: Delphi method; HCV; HCV management
Articolo presente in – Cure and Chronicity N.1 –