Focusing on the theme of “Rapidly Developing Hepatology”, the 17th National Symposium on Viral Hepatitis and Liver Diseases of the Chinese Medical Association (CMA), the Annual Meeting of the Infectious Diseases Branch of the CMA, and the Annual Meeting of the Hepatology Branch of the CMA in 2015 were grandly held at the China National Convention Center (CNCC) in Beijing, and the experts and scholars in the field of hepatology had a two-day symposium. Experts and scholars in the field of liver disease held a two-day symposium, which showed the latest achievements and development trends in the field of hepatology in an all-round way. As the biggest highlight of the conference, the guideline conference held in the afternoon of 25th officially launched the 2015 edition of Chinese Guidelines for Prevention and Treatment of Chronic Hepatitis B and Hepatitis C. The updated points of the 2015 edition of Hepatitis C Guidelines are as follows: Non-invasive diagnosis of liver fibrosis Recommendation 1: Non-invasive diagnostic methods such as serology and/or imaging such as transient elastography can be used to help determine the presence of hepatitis C. diagnostic methods to help determine the presence of hepatitis C cirrhosis or fibrosis. Current noninvasive methods have better diagnostic efficacy for cirrhosis than for significant hepatic fibrosis. Recommendation 2: The combination of noninvasive markers from serology and imaging such as transient elastography may improve the diagnostic accuracy of significant liver fibrosis. When the two results are inconsistent, liver biopsy is recommended for definitive diagnosis. Indications for antiviral therapy Recommendation 3: All HCVRNA-positive patients should receive antiviral therapy as long as they are willing to be treated and have no contraindications to treatment. Recommendation 4: PR regimen is the main regimen of antiviral therapy for HCV currently infected patients in China at this stage, and it can be applied to all genotypes of HCV infection without contraindications to treatment. Recommendation 5: DAAs-based antiviral regimens include DAAs combined with PR, DAAs combined with ribavirin, and combinations or composites of different DAAs, and the three regimens can cover almost all types of HCV-infected patients. Even if medical resources are limited, the decision to prioritize patients for antiviral therapy should be made based on consideration of the patient’s wishes, medical condition and drug accessibility. Polyethylene glycolated interferon alpha in combination with ribavirin for the treatment of first-treatment patients and monitoring Recommendation 6: Standardized antiviral therapy should be administered once the diagnosis of chronic hepatitis C has been confirmed and HCVRNA is detected in the blood. Treatment should be based on a comprehensive assessment of viral load, genotyping, stage of liver fibrosis, and contraindications to antiviral therapy. Recommendation 7: Before DAA is available on the market, PEGIFNα combined with ribavirin is still the main antiviral treatment option for chronic hepatitis C in China. Recommendation 8: Treatment should be individualized according to the viral response during treatment with PEGIFNα combined with ribavirin. Viral response should be assessed using high-sensitivity methods to monitor HCVRNA before treatment and at 4, 12, and 24 weeks of treatment to guide therapy. Recommendation 9: Regardless of genotype, consider discontinuing therapy if HCVRNA decreases <2log at 12 weeks of treatment or remains detectable at 24 weeks. Recommendation 10: Hematology, biochemistry, and HCVRNA, as well as adverse events, should be monitored regularly during treatment. Polyethylene glycolated interferon alpha in combination with ribavirin in patients who have failed to achieve a sustained virologic response on treatment Recommendation 11: Treatment with DAAs should be considered first in patients who have relapsed or failed to respond to prior PR therapy. Recommendation 12: Patients who have not been treated with Peg-IFN-α in combination with ribavirin in prior therapy, or who have been treated with insufficient dose or course of therapy resulting in relapse, may be given Peg-IFN-α in combination with ribavirin for a second 48-week course, with the same principles of therapeutic monitoring and discontinuation as in the initially treated patients. Recommendation 13: Patients who have relapsed on prior therapy may choose to wait for the availability of accessible and suitable drugs for retreatment if there is no urgent need for treatment, such as the absence of the following conditions: significant hepatic fibrosis or cirrhosis (F3-F4), co-infection of HIV or HBV, waiting for liver transplantation, recurrence of HCV after liver transplantation, obvious extrahepatic manifestations, and high-risk individuals for transmitting HCV. (B2) Recommendation 14: Patients who have not been treated with Peg-IFN-α in combination with ribavirin, or who have been treated with insufficient dose or insufficient course of therapy without response, may be given Peg-IFN-α in combination with ribavirin again for a course of up to 72 weeks, and the principles of therapeutic monitoring and discontinuation of therapy are the same as those for patients who have been initially treated. (B2) Recommendation 15: Patients who have not responded to previous standardized treatment can wait for the availability of accessible and suitable drugs for retreatment, but patients with urgent treatment needs should be treated with direct antiviral drugs as soon as possible. Special population antiviral therapy for pediatric patients Recommendation 16: Peg-IFN-α-2a 104 μg/M2 body surface area, Peg-IFN-α-2b 60 μg/M2 body surface area, subcutaneous injection once a week, combined with RBV 15 mg/kg/d, the treatment time is the same as adults. Recommendation 17 for patients with renal insufficiency: Simeprevir, daclatasvir, and ritonavirboosted paritaprevir, ombitasvir, and dasabuvir are all metabolized in the liver and can be used in patients with combined renal insufficiency, whereas patients with an eGFR <30 ml/min/1.73 m2 and end-stage renal disease there is currently no evidence for the use of Sofosbuvir.DAAs regimen is 12 weeks for patients without cirrhosis and 24 weeks for patients with cirrhosis.PEG-IFNα in combination with RBV should be adjusted in dose according to eGFR. Liver transplant patients Recommendation 18: Antiviral therapy should be initiated at least 30 days prior to liver transplantation to prevent post-transplant HCV reinfection. sofosbuvir + RBV (genotype 2), sofosbuvir + ledipasvir (genotypes 1, 4, 5, and 6) or sofosbuvir + daclatasvir + RBV (all genotypes ). Recommendation 19: In patients with recurrence or reinfection after liver transplantation, sofosbuvir+RBV or sofosbuvir+ledipasvir or sofosbuvir+daclatasvir+RBV is preferred for a 12-week course. Patients who have had liver transplantation for more than 3 months may also Peg-IFN-α + RBV for 24-48 weeks or Peg-IFN-α + sofosbuvir + RBV for 12 weeks. Patients with cirrhosis Recommendation 20: Compensated cirrhosis (Child-Pugh class A), apply a standard-dose regimen of Peg-IFN-α in combination with RBV for 48-72 weeks depending on the genotype, Peg-IFN-α + sofosbuvir + RBV for 12-24 weeks, sofosbuvir + daclatasvir , with a course of 12-24 weeks, with a preferred recommendation for IFN-free regimens. Recommendation 21: Decompensated cirrhosis (Child-Pugh class B/C), choose IFN-free and RBV-free regimens, all genotypes can be treated with sofosbuvir+daclatasvir combination for 24 weeks. Choose sofosbuvir + ledipasvir for genotypes 1/4/5/6: 24 weeks of therapy, genotypes 2/3: 16-20 weeks of therapy, IFN-based therapy is contraindicated, and none of the DAAs require dose adjustment. Recommendation 22: All patients with cirrhosis still require liver ultrasound every 6 months to monitor HCC after obtaining SVR. Patients with drug addiction Recommendation 23: The new "triple" regimens based on IFN-free or PEG-IFN are preferred but still need to be evaluated for safety and efficacy. After obtaining SVR, re-infection and re-addiction should be monitored by HCV RNA testing. Recommendation 24: Patients with hemophilia/thalassemia and other blood disorders who have coagulation disorders such as hemophilia and other coagulation disorders who are coinfected with HCV should be treated with the same regimen for HCV as those who are not coinfected with hemophilia. Recommendation 25: When HCV infection is combined with thalassemia, sickle cell anemia and other patients, the anti-HCV treatment plan is the same as that for non-anemic patients, but it is recommended to use the combination of interferon-free and ribavirin-free DAAs, and when ribavirin must be used, attention should be paid to the monitoring of blood counts, etc., and transfusion should be given when necessary. Patients with psychiatric disorders Recommendation 26: HCV patients with a history of psychiatric disorders may be considered for anti-HCV treatment with interferon-free DAAs if conditions permit. Mental status should be assessed prior to anti-HCV treatment, monitored during treatment, and treated with antipsychotics if necessary. Be aware of drug-drug interactions when treating with antipsychotics and anti-HCV drugs. Patients with HBV co-infection Recommendation 27: In the case of co-infection with HBV, the treatment for HCV is the same as that for HCV infection alone. Recommendation 28: Pay attention to the monitoring of HBV DNA while anti-HCV treatment, if HBV DNA is obviously active, nucleoside analog anti-HBV treatment can be given. Recommendation 29: In the case of HIV co-infection, the treatment of HCV is the same as that for HCV alone. Recommendation 30: In HIV co-infection, if HIV is inactive and HCV is acquired, extended courses of pegylated interferon alpha may be considered in patients with genotype 2 or 3 HCV, even if the early response to interferon is poor. Recommendation 31: Consider ledipasvir/sofosbuvir in patients with HCV genotype 1 when co-infected with HIV. Patients with acute hepatitis C Recommendation 32: In patients with acute HCV infection, treatment with pegylated interferon alpha alone is recommended. Recommendation 33: Consider treatment with pegylated interferon alfa in combination with ribavirin for 24 weeks in HIV patients with co-infection of acute HCV. Monitoring and follow-up Recommendation 34: For untreated or treatment-failed patients, review and evaluate the progression of hepatic fibrosis once a year by noninvasive diagnostic modality; Recommendation 35: For patients with underlying cirrhosis, review abdominal ultrasound and AFP every 6 months, regardless of whether or not SVR has been obtained. Issues to be resolved 1. Progression of chronic hepatitis C to cirrhosis, cirrhotic decompensation, and the course of HCC Research on biological markers with early warning effect. 2. Exploration of new regimens for DAA treatment of hepatitis C, especially standardized regimens suitable for all genotypes. 3. Pharmacoeconomic evaluation of DAA and PR treatment strategies. 4, Long-term effectiveness and safety issues after obtaining SVR for DAA treatment of chronic hepatitis C. 5, Study on improvement of disease complications and prognosis after obtaining SVR by DAA treatment of hepatitis C cirrhosis and its decompensated patients. 6, Long-term effects of DAA treatment on prevention of cirrhosis and its complications and HCC. 7.Drug resistance and drug interactions of DAA, especially need to pay attention to the interaction between DAA and Chinese herbs. 8.Further in-depth research on the effectiveness and safety of DAA in special populations: pregnancy, children, co-infection with HIV, renal dysfunction and renal failure, liver transplantation and other patients with hepatitis C five issues. 9, carry out health economics research, explore effective ways to reduce drug prices and improve accessibility of treatment.