What is the most common length of treatment for Hep C?
8 to 12 weeks
How are treatments adjusted for Hep C patients with Genotype 3 or decompensated cirrhosis?
For GT3:
- Epclusa for 12 weeks if non-cirrhotic or compensated cirrhotic without baseline resistance for velpatasvir
- Mavyret
- for 8 weeks
- for 12 weeks w/PT or transplant
- Vosevi for 12 weeks w/PT
For CTP B/C:
- Harvoni plus ribavirin for 12 weeks for GT1 or 24 wks alone
- Epclusa plus ribavirin for 12 weeks for GT1 or 24 wks alone
Which Metavir Score indicates cirrhosis?
F4
How is HCV viral load reported?
HCV RNA or HCV QUANT
What are the 3 categories of cirrhosis, based on CTP scores?
- Class A = 5 to 6 points (compensated)
- Class B = 7 to 9 points (decompensated)
- Class C = 10 to 15 points (decompensated)
Draw the CTP Score table
Ascites: none, mild/mod (diuretic works), severe (diuretic resists)
Encephalopathy: none, grade 1-2 (or precipitated), grade 3-4 (or chronic)
INR: <1.7, 1.7-2.3, >2.3
Bilirubin (mg/dL): <2, 2-3, >3
Albumin (g/dL): >3.5, 2.8-3.5, <2.8
What is the goal of therapy in HCV treatment?
The GOT is a sustained virologic response (SVR), which is undetectable HCV RNA at least 12 weeks after completion
What are the suffixes of the 3 classes of drugs used in HCV treatment?
- Protease Inhitors end with previr
- NS5A inhibitors end in asvir
- NS5B inhibitors end in buvir
What are the 7 commercially available direct acting antivirals?
Harvoni®
Epclusa®
Mavyret®
Vosevi®
Sovaldi®
Zepatier®
Copegus/Ribapak®
What are the 2 pancynogenic first-line regimens for HepC treatment?
Epclusa and Mavyret, but only Epclusa can be used in HCV 1 decompensated cirrhosis and HCV 3 cirrhosis CPT 1
Harvoni is not used in which genotypes?
2 and 3
Zepatier is only used in which genotypes?
1 and 4
Which regimen has a length of therapy of 8 weeks for patients with a viral load <6 million, and not co-infected with HIV?
Harvoni (othewise, it’s 12 weeks); Mavyret is 8 weeks regardless and is pancynogenic (but can not be used in decompensated cirrhosis)
Patients with NS5A polymorphisms should avoid which regimen?
Zepatier, but if needed
- extend tx to 16 weeks and add ribavirin
In HCV and HIV coinfected patients, renal function monitoring is needed when ART contains which drug?
tenofovir
What are the only FDA approved regimens in HCV patients with decompensated cirrhosis?
- Harvoni with ribavirin for 12 weeks
- Epclusa for 12 weeks with ribavirin
What are the only FDA approved regimens to treat HCV in patients who have had a liver transplant?
- Harvoni w/ribavirin for 12 weeks (GT 1 and 4)
- Mavyret w/ribavirin for 12 weeks (GT 1-6)
- 16 weeks if PT for GT1 or GT3
- Epclusa for 12 weeks w/wo ribavirin
What are the only FDA approved regimen to treat HCV in patients who have had a kidney transplant?
Mavyret for
- 12 weeks
- 16 weeks if PT
At what age has the FDA approved each regimen for pediatric patients?
- Harvoni 3yo
- Epclusa 6yoo and 17kg or more
- Mavyret 12yoo and 45kg or more
- Sovaldi 3yoo
Which of the DAA regimens are not PH dependent?
Mavyret and Zepatier
How many times a day is each DAA regimen taken?
- Harvoni QD w/wo food
- Epclusa QD w/wo food
- Mavyret 3 tabs QD w/food
- Vosevi QD w/food
- Ribavirin 1200mg in divided doses w/food
- Zepatier QD w/wo food
- Sovaldi QD w/wo food
Which of the DAA regimens may cause diarrhea?
Harvoni, Vosevi, ribavirin
What are ribavirin’s Black Box Warnings?
- hemolytic anemia resulting in MI
- birth defects and fetal death
