S46(2) Treatment Recommendations Flashcards
Treatment Naïve Without Cirrhosis
HCV Genotype 1a
Elbasvir/grazoprevir x 12 weeks
Glecaprevir/pibrentasvir x 8 weeks
Sofosbuvir/ledipasvir x 8 or 12 weeks
Sofosbuvir/velpatasvir x 12 weeks
Treatment Naïve Without Cirrhosis
HCV Genotype 1a
No NS5A resistance detected
Elbasvir/grazoprevir x 12 weeks
Treatment Naïve Without Cirrhosis
HCV Genotype 1a
8 weeks can be considered in patients without HIV and baseline HCV RNA of < 6 million
Sofosbuvir/ledipasvir x 8 or 12 weeks
Treatment Naïve Without Cirrhosis
HCV Genotype 1b
Elbasvir/grazoprevir x 12 weeks
Glecaprevir/pibrentasvir x 8 weeks
Sofosbuvir/ledipasvir x 8 or 12 weeks
Sofosbuvir/velpatasvir x 12 weeks
Treatment Naïve Without Cirrhosis
HCV Genotype 1b
8 weeks can be considered in patients without HIV and baseline HCV RNA of < 6 million
Sofosbuvir/ledipasvir x 8 or 12 weeks
Treatment Naïve Without Cirrhosis
HCV Genotype 2 and 3
Glecaprevir/pibrentasvir x 8 weeks
Sofosbuvir/velpatasvir x 12 weeks
Treatment Naïve Without Cirrhosis
HCV Genotype 4
Elbasvir/grazoprevir x 12 weeks
Glecaprevir/pibrentasvir x 8 weeks
Sofosbuvir/ledipasvir x 8 or 12 weeks
Sofosbuvir/velpatasvir x 12 weeks
Treatment Naïve Without Cirrhosis
HCV Genotype 4
8 weeks can be considered if baseline HCV RNA is < 6 million, does not have GT 4r, and not prior treatment history
Sofosbuvir/ledipasvir x 8 or 12 weeks
Treatment Naïve With Compensated Cirrhosis
HCV Genotype 1a
Elbasvir/grazoprevir x 12 weeksa
Glecaprevir/pibrentasvir x 8 weeks
Sofosbuvir/ledipasvir x 12 weeks
Sofosbuvir/velpatasvir x 12 weeks
Treatment Naïve With Compensated Cirrhosis
HCV Genotype 1a
no NS5A resistance detected
Elbasvir/grazoprevir x 12 weeks
Treatment Naïve With Compensated Cirrhosis
HCV Genotype 1a
not co-infected with HIV
Glecaprevir/pibrentasvir x 8 weeks
Treatment Naïve With Compensated Cirrhosis
HCV Genotype 1b
Elbasvir/grazoprevir x 12 weeks
Glecaprevir/pibrentasvir x 8 weeks
Sofosbuvir/ledipasvir x 12 weeks
Sofosbuvir/velpatasvir x 12 weeks
Treatment Naïve With Compensated Cirrhosis
HCV Genotype 1b
not co-infected with HIV
Glecaprevir/pibrentasvir x 8 weeks
Treatment Naïve With Compensated Cirrhosis
HCV Genotype 2 and 3
Glecaprevir/pibrentasvir x 8 weeks
- not co-infected with HIV
Sofosbuvir/velpatasvir x 12 weeks
- Pretreatment resistance testing recommended
Treatment Naïve With Compensated Cirrhosis
HCV Genotype 4
Elbasvir/grazoprevir x 12 weeks
Glecaprevir/pibrentasvir x 8 weeks
Sofosbuvir/ledipasvir x 12 weeks
Sofosbuvir/velpatasvir x 12 weeks
Treatment Naïve With Compensated Cirrhosis
HCV Genotype 4
not co-infected with HIV
Glecaprevir/pibrentasvir x 8 weeks
HCV Decompensated Cirrhosis
Defined as CTP Class B or C cirrhosis
Should be managed by a liver expert
Avoid NS3/4A protease inhibitors
Ribavirin is usually added or treatment extended to 24 weeks
HCV Persons Who Inject Drugs
Not a contraindication for treatment
Multi-disciplinary approach
At risk for re-infection
HCV Alcoholism
Cessation is recommended
Use is not a reason to prevent or delay treatment
HCV Genotype 3
Most difficult to treatment in the setting of prior treatment and/or cirrhosis
HCV DAA Experienced
Usually retreated with sofosbuvir/velpatasvir/voxilaprevir
HCV HIV Co-infection
No significant difference with treatment or response
Potential for drug-drug interactions
HCV HBV Co-infection
Must screen at baseline due to risks of re-activation
Requires treatment and/or monitoring while on DAA therapy
HCV Pregnancy and Children
No FDA approved treatment for pregnancy
Sofosbuvir/ledipasvir approved for ≥ 3 years
Glecaprevir/pibrentasvir approved for ≥ 12 years
HCV Monitoring Post treatment
Hypoglycemia for diabetic patients INR for patients on warfarin HCV viral load 12 weeks post treatment HCC surveillance via imaging every 6 months for cirrhotics Re-infection in those at risk
