Therapeutics of HCV

Question 1

SVR 12 means

Answer 1

Sustained virologic response 12 weeks

MEANS THEY ARE CURE

Question 2

85% of HCV

Answer 2

Become chronic

Question 3

Screening for HCV

Answer 3

Risk exposure (blood exposure, transfusion before 1992, tattoo)
Risk behavior (injection drug use, intranasal drug use
HIV infection
Unexplained chronic liver disease
Born between 1945-1965

Question 4

HCV Diagnosis

Answer 4

Hep C antibody (if it is positive then you have the infection) Then look at HCV RNA (if it is detected you have a current infection) Then get genotypes to start treatment

Question 5

HCV Blood Test

Answer 5

HCV Antibody test
HCV RNA
Genotypes

Question 6

Direct Acting Agents (DAA)

Answer 6

NS3/4A protease inhibitors
NS5A inhibitors
NS5B polymerase inhibitors (NRTIs or NNRTIs)

Question 7

Goals of Hep C Treatment

Answer 7

Undetectable viral load (HCV RNA) 12 weeks post treatment
Reduce HCV RNA titer, disease progression, risk of cancer, need to liver transplant)
Improve liver histology

Question 8

Pre-Treatment Eval for HCV

Answer 8

Positive antiHCV
Baseline HCV RNA
Genotype and subtype
Liver fibrosis stage
HIV status
Vaccinations
Pregnacy test for ribavirin

Question 9

Non-DAA options

Answer 9

• PegIFN alfa-2a (Pegasys) weekly
• PegIFN alfa-2b (Peg-Intron per kg SQ weekly
• Ribavirin PO divided BID

Question 10

DAA Options

Answer 10

Sofosbuvir (Sovaldi)
Simeprevir (olysi) - genotype 1 only
Viekira Pak

Question 11

Viekira Pak Drugs

Answer 11

Ombitasvir (NS5A inhibitor)
Partaprevir (HS3/4A inhibitor)
Ritonavir (booster of partaprevir)
Dasabuvir (NS5B inhibitor)

Question 12

CI to PegIFN

Answer 12

Plt less than 75
CrCl less than 50 mL/min
Psychiatric instability

Question 13

Pegasys

Answer 13

PegIFN alpfa-2a
NOT weight based
WEEKLY SQ
REFRIDGERATED

Question 14

Peg-Intron

Answer 14

PegIFN alfa-2b
WIGHT BASED SQ WEEKLY
Refrigerated
Reconstituted with sterile water

Question 15

Ribavirin for HCV Treatment

Answer 15

Ineffective as monotherapy
WEIGHT BASED
Give WITH IFN

Question 16

Ribavirin CI

Answer 16

**ANEMIA (less than 13 in males less than 12 in females)

PREGNANCY

Question 17

Ribavirin AE

Answer 17

Anemia and rash or pruritis

Question 18

Sofosbuvir

Answer 18

Genotype 1-3
Typically given with other medications
***LOTS OF DRUG INTERACTIONS + P-gp substrate

Question 19

Harvoni

Answer 19

BEST DRUG FOR HEP C
1 tablet PO daily
REQUIRES ACIDIC ENVIRONMENT FOR ABSORPTION, separate from antacids, H2RAs and PPIs

Question 20

Harvoni DI

Answer 20

Seizure Meds

Question 21

Simeprevir (olysio)

Answer 21

Genotype 1 or 4
*****NOT genotype 1a + NS3Q80K polymorphism!!!!!!
SULFA Drug!!!
CYP3A4

Question 22

Viekira Pack

Answer 22

LOTS of interactions

CI: birth controls, NNRTI (HIV drugs**), SEIZURE meds

Question 23

Daclatasvir (Daklinza)

Answer 23

Genotype 3
COMBO with sofosbuvir
No co-administration with IFN or Ribavirin
CI: CYP3A4
Once daily x 12 weeks

Question 24

Technivie

Answer 24

Genotype 4 WITHOUT cirrosis

Once daily

Question 25

**Initial Treatment of HCV Genotype 1a

Answer 25

Harvoni for 12 weeks (no seizure meds)
Viekira Pak + RBV for 12 weeks (no cirrhosis) or 24 weeks (with cirrhosis)
Sovaldi + Olysio +/- RBV for 12 weeks (no cirrhosis) or 24 weeks (with cirrhosis)

Question 26

**Initial Treatment of HCV Genotype 1b

Answer 26

Harvoni for 12 weeks (no seizure meds)
Viekira Pak for 12 weeks + RBV if cirrhosis*****
Sovaldi + Olysio +/- RBV for 12 weeks (no cirrhosis) or 24 weeks (with cirrhosis)

Question 27

***HCV Monitoring

Answer 27

CBC, SCr, GFR, LFTs after 4 weeks of treatment and 12 weeks AFTER treatment
**HCV RNA 4 weeks into treatment, end of treatment and 12 weeks after completing treatment for cure