cART + HCV Flashcards
1
Q
When should you initiate cART
A
- Time of dx, regardless of CD4 count
- Prevention efforts
2
Q
What is the standard of care regimen for cART
A
- 3 drugs
- 2 NRTIs (FTC + TDF or TAF) + 1 (any) INSTI OR + (boosted) PI (DRV)
- Most common is Bictegravir/tenofovir alafenamide/emtricitabine (Bictarvy)
3
Q
Goal of viral load count in cART
A
- <400 copies/mL
- <50 copies/mL (ultrasensitive)
4
Q
cART pearls
A
- Patient must be ready
- Therapy is lifelong
- Therapy is generally never “urgent”
5
Q
What are the 4 Direct-Acting Antiviral (DAAs) classes for HCV?
A
- Nonstructural proteins 3/4A (NS3/4A) Protease Inhibitors (PI)
- Nonstructural protein 5A (NS5A) inhibitors
- Nonstructural protein 5B (NS5B) Nucleoside Polymerase Inhibitors (NPIs)
- Nonstructural protein 5B (NS5B) Non-Nucleoside Polymerase Inhibitors (NNPIs)
6
Q
NS3/4A Protease Inhibitors
A
- Glecaprevir (only combined with pibrentasvir–> Mavyret)
- MOA: inhibits NS3/4A protease (HCV replication)
- ADRs: rash, photosensitivity, hyperbili
7
Q
NS5A Inhibitors
A
- Ledipasvir (only combined with sofosbuvir as Harvoni)
- Velpatasvir (combined with sofosbuvir as Epclusa)
- Pibrentasvir (only combined with glecaprevir –> Mavyret)
- MOA: inhibit viral replication by binding to NS5A protein
- ADRs: HA, fatigue, nausea
8
Q
NS5B Inhibitors
A
- Sofosbuvir (NPI)
- Dasabuvir (NNPI)
- MOA: inhibit NS5B polymerase at nucleoside/nucleotide analog (NPI), or non-nucleoside analog (NNPI)
- NO AMIODORONE with sofobuvir** (sx bradycardia)
9
Q
Bolded Fixed dose combos
A
- Ledipascvir (NS5A)-sofosbuvir (NS5B) (Harvoni)
- Sofosbuvir (NS5B)-velpatasvir (NS5A) (Epclusa)
- Glecaprevir (NS3/4A PI)-pibrentasvir (NS5A) (Mavyret)
10
Q
Initiating HCV tx
A
- Check genotype (types 1-6, 75% of genotype 1)
- Epclusa, Harvoni, Mavyret are most commonly used for tx naïve patients
