Summary of Current Recommendations (refer to Appendix)

The management of patients with HCV disease is evolving. In this document, we have attempted to provide a guide for the care of HCV-infected patients rather than to dictate absolute rules for practice. Treatment should be provided to those individuals who meet criteria for treatment and who are at greatest risk for progressive liver disease. Many of these patients will have relative contraindications to treatment, often because of concomitant psychiatric disease or other comorbid conditions. Close collaboration is necessary with specialists, including psychiatrists and substance abuse providers, to manage these comorbid conditions that represent barriers to the initiation of HCV antiviral therapy. Given the potential adverse events associated with antiviral therapy, patients should be counseled on their likelihood of achieving SVR (based upon individual factors such as body mass index, genotype, race, stage of fibrosis, and viral load) before initiating therapy.