HCV Treatment

Question 1

Sofosbuvir MoA

Answer 1

Nucleotide NS5B polymerase inhibitor

SofosBuvir, NS5B

Question 2

What genotypes does sofosbuvir treat?

Answer 2

1-4

Question 3

Sofosbuvir dose

Answer 3

400mg PO QD (used as a backbone for therapies)

Question 4

Sofosbuvir duration of treatment

Answer 4

Up to 48 weeks

Question 5

Ledipasvir MoA

Answer 5

NS5A inhibitor

LedipAsvir (NS5A)

Question 6

Sofosbuvir/ledipasvir indication (what genotypes)

Answer 6

Genotype 1 only (but also treats 4-6?)

Question 7

Duration of treatment for sofosbuvir/ledipasvir (with and without cirrhosis)

Answer 7

12 weeks without cirrhosis

24 weeks with cirrhosis

Question 8

CrCl requirement for sofosbuvir/ledipasvir

Answer 8

CrCl >30ml/min

Question 9

Duration of treatment for sofosbuvir/ledipasvir when the patient has cirrhosis

Answer 9

24 weeks

Question 10

Sofosbuvir/ledipasvir dosing

Answer 10

1 tab PO QD (90mg ledipasvir, 400mg sofosbuvir)

Question 11

Sofosbuvir ADEs

Answer 11

Bradycardia with amiodarone, fatigue, HA, nausea

Question 12

Velpatasvir MoA

Answer 12

NS5A protease inhibitor

Question 13

Velpatasvir/Sofosbuvir indication (genotypes)

Answer 13

1-6

Question 14

Velpatasvir/sofosbuvir dosing

Answer 14

100mg capsule of velpatasvir, 400mg of sofosbuvir QD

Question 15

Duration of treatment for velpatasvir/sofosbuvir

Answer 15

12 weeks with or without cirrhosis

Question 16

ADEs of velpatasvir/sofosbuvir

Answer 16

headache, fatigue

Question 17

Glecaprevir/pibrentasvir indication (what genotypes)

Answer 17

1-6

Question 18

Glecaprevir/pibrentasvir dosing

Answer 18

1 tab PO QD with food (100mg glecaprevir, 40mg pibrentasvir)

Question 19

Duration of treatment for glecaprevir/pibrentasvir without cirrhosis

Answer 19

8 weeks

Question 20

Duration of treatment for glecaprevir/pibrentasvir with cirrhosis

Answer 20

12 weeks

Question 21

ADEs of glecaprevir/pibrentasvir

Answer 21

fatigue, headache

Question 22

CIs for glecaprevir/pibrentasvir

Answer 22

Severe hepatic impairment, coadministration with atazanavir and rifampin

Question 23

Elbasvir/grazoprevir indication (what genotypes)

Answer 23

1 with or without cirrhosis

4

Question 24

Elbasvir/grazoprevir dosing

Answer 24

Grazoprevir 100mg, elbasvir 50mg

Question 25

CIs to elbasvir/grazoprevir

Answer 25

Moderate-severe hepatic impairment (Child-Pugh B or C), OATP1B1/3 inhibitors, CYP3A inducers and efavirenz

Question 26

ADEs to elbasvir/grazoprevir

Answer 26

fatigue, headache, nausea

Question 27

Duration of treatment for elbasvir/grazoprevir for genotype 1 infection

Answer 27

12 weeks

Question 28

CrCl Velpatasvir requirement

Answer 28

>30ml/min

Question 29

Duration of treatment for elbasvir/grazoprevir for patients with NS5A polymorphisms and ribavirin

Answer 29

16 weeks

Question 30

Treatment of chronic HCV GT1A

Answer 30

GLE/PIB x8 weeks VEL/SOF x12 weeks LDV/SOF x12 weeks (8 weeks if no cirrhosis, non-Black, HIV and HCV RNA <6 million IU/ml)

Question 31

Alternative treatment for GT1A

Answer 31

EBR/GZR x12 weeks without NS5A polymorphism

Question 32

Treatment of GT1B

Answer 32

Same treatments as GT1A

Question 33

Treatment of GT 2 and 3

Answer 33

GLE/PIB x8 weeks | VEL/SOF x12 weeks

Question 34

Alternatives for GT3 treatment

Answer 34

VEL/SOF and RBV x12 weeks (cirrhosis, NS5A RAS Y93H) | VEL/VOX/SOF x12 weeks

Question 35

Treatment of GT 4

Answer 35

GLE/PIB x8 weeks VEL/SOF x12 weeks LDV/SOF x12 weeks EBR/GZR x12 weeks

Question 36

Treatment of GT 5 and 6

Answer 36

GLE/PIB x8 weeks VEL/SOF x12 weeks LDV/SOF x12 weeks

Question 37

Treatment for patients with renal dysfunction (CrCl <30ml/min) with no cirrhosis and high urgency to treat with GT 1a, 1b, and 4

Answer 37

EBR/GZR x12 weeks

Question 38

Treatment for patients with renal dysfunction (CrCl <30ml/min) with no cirrhosis and high urgency to treat with GTs 1-6

Answer 38

GLE/PIB for 8-16 weeks

Question 39

Drug efficacy/monitoring: 4 week mark

Answer 39

CBC, SCr, LFTs, HCV RNA Stop therapy if >10x increase in ALT or <10x increase with evidence of decompensation Repeat HCV RNA test at week 6 if positive

Question 40

Drug efficacy/monitoring: 6 week mark

Answer 40

HCV RNA if positive at week 4 | Stop therapy of 10-fold increase

Question 41

Drug efficacy/monitoring: 12 week mark

Answer 41

TSH | Consider HCV and stop most therapies

Question 42

Drug efficacy/monitoring: 24 weeks

Answer 42

HCV RNA, assess for SVR | Stop 16-week regimens and check SVR longer