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Canadian Journal of Gastroenterology
Volume 26, Issue 6, Pages 359-375
Special Article

An Update on the Management of Chronic Hepatitis C: Consensus Guidelines from the Canadian Association for the Study of the Liver

Robert P Myers,1 Alnoor Ramji,2 Marc Bilodeau,3 Stephen Wong,4 and Jordan J Feld5

1Liver Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
2Department of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
3Liver Unit, Department of Medicine, University of Montreal, Montreal, Quebec, Canada
4Section of Hepatology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
5Toronto Western Hospital Liver Centre, University of Toronto, Toronto, Ontario, Canada

Copyright © 2012 Canadian Association for the Study of the Liver. This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) (, which permits reuse, distribution and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes.


Chronic hepatitis C remains a significant medical and economic burden in Canada, affecting nearly 1% of the population. Since the last consensus conference on the management of chronic hepatitis C, major advances have warranted a review of recommended management approaches for these patients. Specifically, direct-acting antiviral agents with dramatically improved rates of virological clearance compared with standard therapy have been developed, and several single nucleotide polymorphisms associated with an increased probability of spontaneous and treatment-induced viral clearance have been identified. In light of this new evidence, a consensus development conference was held in November 2011; the present document highlights the results of the presentations and discussions surrounding these issues. It reviews the epidemiology of hepatitis C in Canada, preferred diagnostic testing approaches and recommendations for the treatment of chronically infected patients with the newly approved protease inhibitors (boceprevir and telaprevir), including those who have previously failed pegylated interferon and ribavirin therapy. In addition, recommendations are made regarding approaches to reducing the burden of hepatitis C in Canada.