Hep C

Question 1

Hep C Infections

Answer 1

Acute or chronic. Acute is self-limiting. Chronic is progressive to liver failure over decades. Co-infection with Hep B and HIV are common; more rapid progression. Hep B can be reactivated while treating Hep C

Question 2

Treatment Overview

Answer 2

Antiviral Therapy; Hep C can be eliminated.
Dose adjustments only after the disease progresses.
Vaccinations are important.
Goal: Eradicate HCV RNA to an undetectable level 12 wks after treatment completion; Sustained Virologic Response (SVR).
Regimen selection depends on genotype of HCV, co-infections, etc

Question 3

Overview of Agents

Answer 3

Protease Inhibitors
NS5A Inhibitors
NNPI
NS5B Polymerase Inhibitors

Question 4

Preferred Regimens

Answer 4

G/P 8 wks
L/S 12 wks
S/V 12 wks

Question 5

Glecaprevir/Pibrentasvir

Answer 5

Mavyret
IND: Chronic Hep C
MOA: G: Protease inhibitor; inhibits viral replication.
P: NS5A inhibitor; inhibits viral RNA replication inhibitor and viral assembly
BOX: Hep B reactivation
CON: Mod-severe hepatic impairment, Hx of hepatic decompensation, use with Atazanavir or Rifampin
ADR: Nausea, fatigue, HA

Question 6

Ledipasvir/Sofosbuvir

Answer 6

Harvoni
IND: Chronic Hep C
MOA: L: NS5A inhibitor
S: NS5B inhibitor; inhibits viral replication
BOX: Hep B reactivation
CON: n/a
ADR: HA, fatigue, asthenia

Question 7

Sofosbuvir/Velpatasvir

Answer 7

Epclusa
IND: Chronic Hep C
MOA: NS5B and NS5A
BOX: Hep B
CON: n/a
ADR: fatigue, HA

Question 8

Elbasvir/Grazoprevir

Answer 8

Zepatier
IND: Chronic Hep C
MOA: HS5A inhibitor and G-protease inhibitor
BOX: Hep B
CON: Hepatic impairment, Hx of hepatic decompensation, use with OATP1B1/3 inhibitors and CYP3A4 inducers; ALWAYS use a DI checker
ADR: fatigue

Question 9

Monitoring Therapy

Answer 9

To check for viral resistance and adherence issues.
Checked at wk 4, re-check at wk 6. Too high at 6, switch therapies
Check SVR at 12 wks and 24 wks POST-d/c
Does not confer immunity to HCV, can be reinfected

Question 10

Ribavirin

Answer 10

OLD and SUCK
IND: Chronic Hep C
MOA: Inhibit RNA replication
BOX: Hemolytic anemia; may result in worsening cardiac dz (potentially fatal)
Pregnancy-Teratogenic and embryocidal
CON: Pregnancy, severe renal impairment, hepatic impairment
ADR: Tons of ADRs