Hepatitis

Question 1

Natural history HBV

Answer 1

Younger age of infection: greater risk of chronic infection:

90% in infancy
20% upto 5 years
10% after that

Perinatal transmission 90% if baby not immunised and mum high infectivity

<5% with intervention

Perinatal transmission 20-40% if baby not immunised and mum low infectivity

Question 2

HCV Tx

Answer 2

WHO recommends offering treatment to all individuals diagnosed with HCV infection who are 3 years of age or older, irrespective of disease stage (EXCEPT PREGNANT WOMEN)

WHO recommends the use of pangenotypic DAA regimens for the treatment of persons with chronic HCV infection aged 3 years and above

DAAs are considered pangenotypic when they achieve high treatment efficacy across all six major HCV genotypes (1-6).

For adults without cirrhosis, the following pangenotypic regimens can be used:
• Sofosbuvir/velpatasvir 12 weeks
• Sofosbuvir/daclatasvir 12 weeks
• Glecaprevir/pibrentasvir 8 weeks

For adults with compensated cirrhosis, the following pangenotypic regimens can be used:
• Sofosbuvir/velpatasvir 12 weeks
• Glecaprevir/pibrentasvir 12 weeks
• Sofosbuvir/daclatasvir 12 weeks
• Sofosbuvir/daclatasvir 24 weeks if previously treated

Nucleic acid testing for qualitative or quantitative detection of HCV RNA should be used as the test of cure at 12 or 24 weeks (i.e. sustained virological response [SVR12 or SVR24]) after completion of antiviral treatment.

Systematic reviews of the effectiveness of DAAs for the treatment of chronic HCV infection indicate that SVR rates generally exceed 90%