Hepatitis C Flashcards
Who does USPSTF recommend screening for HepC?
pts born bt 1945-1965
What is the MC HepC genotype
genotype 1
What factors determine treatment eligibility in HepC?
HCV genotype cirrhosis (absent, compensated, decompensated) prior tx liver transplant other health conditions
What is the duration for most HepC treatment regimens?
6-24weeks
NS3/4A protease inhibitors: MOI
prevent polyprotein processing
inhibits HCV replication directly binding to the NS3/4A protease that cleaves HCV encoded polyproteins
NS5B inhibitors: MOI
inhibit RNA dependent RNA polymerase activity
NS5A inhibitors: MOI
prevent viral assembly and formation of RNA replication complex
NS3/4A protease inhibitors: agents, targeted genotypes
“previr”
Simeprevir (1, 4) Paritaprevir (1, 4) Asunaprevir (1, 4) Grazoprevir (1, 4-6) Glecaprevir (1-6) Voxilaprevir (1-6)
NS5B inhibitors: agents, targeted genotypes
“buvir”
sofosbuvir (1-6)
dasabuvir (1, 4)
beclabuvir (1)
NS5A inhibitors: agents, targeted genotypes
“asvir”
Daclatasvir (1-6) Ledipasvir (1, 4-6) Ombitasvir (1,4) Elbasvir (1-6) Velpatasvir (1-6) Pibrentasvir (1-6)
Genotype 1 Specific Medications
Daklinza (daclatasvir) with Sovaldi (sofosbuvir) +/- ribavirin.
Harvoni (ledipasvir/sofosbuvir) +/- ribavirin
Olysio (simprevir) plus Sovaldi (sofosbuvir) +/- ribavirin
Viekira Pak (ombitasvir/paritaprevir/ritonavir tablets; dasabuvir) + ribavirin
Viekira XR (ombitasvir, paritaprevir, ritonavir, dasabuvir) + ribavirin
Zepatier (elbasvir/grazoprevir) +/- ribavirin
Genotype 2 Specific Medications
Sovaldi (sofosbuvir) + ribavirin
Genotype 3 Specific Medications
Daklinza (daclatasvir) with Sovaldi (sofosbuvir) +/- ribavirin.
Sovaldi (sofosbuvir) + ribavirin
Genotype 4 Specific Medications
Harvoni (ledipasvir/sofosbuvir) +/- ribavirin
Sovaldi (sofosbuvir) + ribavirin
Technivie (ombitasvir/paritaprevir/ritonavir) + ribavarin
Zepatier (elbasvir/grazoprevir) +/- ribavirin
Vosevi: agents, ADE
(pan-genotypic)
sofosbuvir/velpatasvir/voxilapresvir
HA
tiredness
diarrhea
nausea
Epclusa: drug interactions
take antacids containing Al, Mg 4hrs from Epclusa
inc levels of amiodarone –> bradycardia
dec level of epclusa w/ AED, proton pump inhibitors of H2
inc levels of statin med
dec efficacy w/ rifampin, st john’s wart
interaction w/ HIV meds
Mavyret: drug interactions
reduced success w/ atazanavir, rifampin
can take digoxin concurrently
not recommended w/ immunosuppressants (cyclosporine)
Mavyret + OCP –> inc ALT levels
inc levels of statin med
dec efficacy w/ rifampin, st john’s wart
dec level of mavyret w/ AED, proton pump inhibitors of H2
interaction w/ HIV meds
Vosevi: drug interactions
do not take BCRP substrate w/ vosevi
take antacids containing Al, Mg 4hrs from Epclusa
inc levels of amiodarone –> bradycardia
inc levels of statin med
dec efficacy w/ rifampin, st john’s wart
dec level of vosevi w/ AED, proton pump inhibitors of H2
interaction w/ HIV meds
Vosevi: drug interactions
do not take BCRP substrate w/ vosevi
take antacids containing Al, Mg 4hrs from Epclusa
inc levels of amiodarone –> bradycardia
inc levels of statin med
dec efficacy w/ rifampin, st john’s wart
dec level of vosevi w/ AED, proton pump inhibitors of H2
interaction w/ HIV meds
Epclusa: drug interactions
take antacids containing Al, Mg 4hrs from Epclusa
inc levels of amiodarone –> bradycardia
dec level of epclusa w/ AED, proton pump inhibitors of H2
inc levels of statin med
dec efficacy w/ rifampin, st john’s wart
interaction w/ HIV meds
Mavyret: drug interactions
reduced success w/ atazanavir, rifampin
can take digoxin concurrently
not recommended w/ immunosuppressants (cyclosporine)
Mavyret + OCP –> inc ALT levels
dec level of mavyret w/ AED
inc levels of statin med
dec efficacy w/ rifampin, st john’s wart
interaction w/ HIV meds
Vosevi: drug interactions
do not take BCRP substrate w/ vosevi
take antacids containing Al, Mg 4hrs from Epclusa
inc levels of amiodarone –> bradycardia
dec level of vosevi w/ AED, proton pump inhibitors of H2
inc levels of statin med
dec efficacy w/ rifampin, st john’s wart
interaction w/ HIV meds
Daklinza with Sovaldi +/- ribavirin: genotype, ADEs
genotype 1
genotype 3
fatigue
HA
nausea
anemia
Harvoni +/- ribavirin: genotype, ADEs
genotype 1
genotype 4
genotype 5
genotype 6
fatigue
HA
neuromuscular/skeletal weakness
w/ ribavirin:
weakness
HA
cough
Olysio plus Sovaldi +/- ribavirin: genotype, ADEs
genotype 1
fatigue HA nausea insomnia itching rash photosensitivity dizziness diarrhea
Viekira Pak + ribavirin: genotype, ADEs
genotype 1
nausea
itching
sleep problems
w/ribavirin: tiredness nausea itching sleep problems feeling weak skin reactions (redness, rash)
Viekira XR + ribavirin: genotype, ADEs
genotype 1
nausea
itching
sleep problems
w/ribavirin: tiredness nausea itching sleep problems feeling weak skin reactions (redness, rash)
Zepatier +/- ribavirin: genotype, ADEs
genotype 1
genotype 4
fatigue
HA
nausea
w/ribavirin: anemia HA fatigue SOB rash itching
Sovaldi + ribavirin: genotype, ADEs
genotype 2
genotype 3
genotype 4
fatigue
HA
Why do we administer HepB vaccine prior to HepC treatment?
new anti viral therapies can re activate past HepB infx
may also need HepA vaccine
