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EBAC - Infectious Disease > Hepatitis C Virus > Flashcards

Hepatitis C Virus Flashcards

(67 cards)

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1
Q

What is the family of the Hepatitis C virus (HCV)?

A

Flaviviridae

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2
Q

How many genotypes and subtypes are known for HCV?

A

Seven genotypes and 84 subtypes

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3
Q

Which HCV genotypes are the most common worldwide?

A

Genotypes 1 and 3

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4
Q

What was the estimated global prevalence of chronic HCV infection in 2019?

A

58 million (0.8% of the general population)

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5
Q

What percentage of adults in the United States were estimated to be HCV antibody positive from 2013 to 2016?

A

1.7% of all adults

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6
Q

What is the estimated prevalence of HCV RNA positive individuals in the United States from 2013 to 2016?

A

1% of all adults

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7
Q

What factors contributed to the decline in HCV prevalence estimates from 2015 to 2019?

A
  • Increased cures with new treatment options
  • Increasing death rates due to aging
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8
Q

What is the estimated prevalence of HCV coinfection among people with HIV?

A

6.2%

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9
Q

What is the increased risk of HCV infection in people with HIV compared to those without?

A

Six times higher

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10
Q

What are the primary transmission routes for HCV?

A
  • Percutaneous exposure to blood
  • Sexual intercourse
  • Perinatal transmission
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11
Q

True or False: HCV is less infectious than HIV through percutaneous blood exposures.

A

False

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12
Q

What is the most common mode of HCV acquisition in the United States?

A

Injection drug use

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13
Q

What percentage of infants born to HCV-positive mothers without HIV are affected by perinatal transmission?

A

Approximately 7%

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14
Q

What percentage of infants born to HCV-positive mothers with HIV are affected by perinatal transmission?

A

Approximately 12%

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15
Q

What are common symptoms of acute HCV infection?

A
  • Low-grade fever
  • Mild right-upper-quadrant pain
  • Nausea
  • Vomiting
  • Anorexia
  • Dark urine
  • Jaundice
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16
Q

What is the risk of developing cirrhosis in patients with chronic HCV infection?

A

20 to 40% within 20 years

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17
Q

What factors increase the risk for significant liver disease in HCV patients?

A
  • Older age at the time of infection
  • Male sex
  • Obesity
  • Concomitant alcohol use
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18
Q

What is the role of HCV screening in HIV care?

A

All patients should undergo routine HCV screening on entry into HIV care

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19
Q

What type of testing is recommended for HCV in at-risk individuals?

A

HCV antibody testing annually or as indicated

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20
Q

What should be done for individuals who test positive for HCV antibody?

A

Additional diagnostic testing using a sensitive quantitative assay for HCV RNA level

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21
Q

What is the primary method for preventing HCV transmission among people who inject drugs?

A

Harm-reduction strategies including syringe services programs

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22
Q

What is the recommended action for those with acute HCV infection?

A

Immediate treatment with regimens recommended for chronic HCV

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23
Q

What is the association between HBV and HCV coinfection?

A

Coinfection with HBV is associated with increased morbidity

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24
Q

What should patients with HCV infection avoid to prevent liver damage?

A
  • Alcohol consumption
  • Potentially hepatotoxic medications
  • Iron supplementation in the absence of deficiency
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25
What treatment regimens are preferred for HCV infection?
Direct-acting antiviral (DAA) regimens
26
What are the goals of therapy for patients with HIV/HCV coinfection?
Similar to those recommended for HCV mono-infection
27
How has the approach to HCV treatment changed for non-specialist providers?
Simplified approaches have emerged to facilitate treatment
28
What is the main purpose of simplified approaches to HCV treatment?
To facilitate treatment by non-specialist providers and increase treatment uptake for the majority of persons with HCV infection.
29
Who can generally qualify for simplified HCV treatment?
Treatment-naive persons without cirrhosis.
30
What are the key components of simplified HCV treatment?
* Minimal baseline testing (omission of genotype) * Standardized treatment approaches using pangenotypic regimens * No on-treatment testing or in-person follow-up * Limited follow-up to confirm sustained virologic response (SVR)
31
What has eliminated clinically significant drug interactions in HCV treatment for people with HIV?
The emergence of unboosted integrase strand transfer inhibitor (INSTI)-based ARV regimens.
32
What is the significance of the AIDS Clinical Trial Groups (ACTG) A5360 study?
It evaluated a simplified approach consisting of limited baseline testing and supply of the entire sofosbuvir/velpatasvir treatment regimen, showing a 95% SVR in participants with HIV.
33
What was the SVR after 12 weeks post-treatment in the ACTG A5360 study?
95% overall and 95% in the subset of people with HIV.
34
What did the SMART-C study compare?
A standard 8-week treatment with glecaprevir/pibrentasvir versus a simplified approach that omitted on-treatment visits.
35
What was the SVR12 for the simplified approach in the SMART-C study?
97%.
36
What is the recommended assessment for patient readiness before HCV treatment?
A pre-HCV treatment assessment indicating that reasonable adherence can be expected.
37
Is treatment for HCV recommended if a patient has untreated HIV infection?
Yes, treatment should not be withheld solely due to perceived lack of adherence with HIV therapy.
38
What is the recommended assessment for fibrosis stage in people with HIV?
Additional fibrosis stage assessment may be indicated if FIB-4 score is indeterminate.
39
What is the preferred method for liver fibrosis staging?
Non-invasive ultrasound-based or imaging-based modalities.
40
What should not be withheld if access to additional staging modalities is not available?
HCV treatment.
41
What exclusions are noted for simplified HCV treatment in people with HIV?
* Prior HCV treatment * Decompensated cirrhosis * TDF-containing regimen with eGFR <60 mL/min * On efavirenz, etravirine, nevirapine, or boosted HIV-1 protease inhibitors * Untreated chronic HBV infection * Pregnancy
42
What is required for pre-treatment assessment under the simplified approach?
* Creatinine, liver function tests, and complete blood count * HCV RNA * Hepatitis B surface antigen * Initial fibrosis staging with FIB-4 * Medication and drug interaction review
43
What is a significant drug interaction concern when using efavirenz with HCV DAAs?
Efavirenz coadministration results in a significant decrease in glecaprevir, pibrentasvir, and velpatasvir exposures.
44
What is the recommended DAA regimen for HCV treatment-naive persons without cirrhosis?
* Glecaprevir/pibrentasvir FDC for 8 weeks * Sofosbuvir/velpatasvir FDC for 12 weeks
45
What was the SVR12 in the ASTRAL-5 study for sofosbuvir/velpatasvir?
95%.
46
What is recommended if compensated cirrhosis is present and sofosbuvir/velpatasvir is planned?
Pre-treatment HCV genotyping is recommended.
47
What is the significance of the EXPEDITION-2 study regarding glecaprevir/pibrentasvir?
It showed an SVR12 of 98% in participants with HIV, including those with cirrhosis.
48
What is the recommendation for HCV treatment in acute HCV infection for people with HIV?
HCV treatment should be started as soon as possible.
49
What should patients who achieve viral clearance be counseled about?
The potential for reinfection.
50
What is the recommended timing for starting HCV treatment in people with HIV?
As soon as possible to reduce onward transmission and benefit the individual ## Footnote This is classified as AIII recommendation.
51
What are simplified treatment regimens recommended for?
Acute HCV infection ## Footnote This is classified as AII recommendation.
52
What should patients who achieve viral clearance be counseled about?
The potential for reinfection
53
Why were persons with HIV excluded from certain DAA treatment trials?
They were not included in registrational trials for sofosbuvir/velpatasvir/voxilaprevir and initial trials for glecaprevir/pibrentasvir.
54
How should treatment approaches for DAA failures in people with HIV compare?
They should be the same as those for persons with HCV mono-infection ## Footnote This is based on AIII recommendation.
55
Is laboratory monitoring required for patients on simplified treatment?
No, it is not required.
56
What documentation may be required by payors during treatment?
Documentation of HCV RNA levels at week 4 of therapy.
57
What is the recommended follow-up after completing HCV therapy?
Document SVR (HCV RNA less than lower limits of quantification) at least 12 weeks after completion of therapy ## Footnote This is classified as AI recommendation.
58
How often should HCV reinfection assessments be conducted?
At least yearly for those with ongoing risk behaviors.
59
What is the screening recommendation for hepatocellular carcinoma in patients with cirrhosis?
Liver ultrasound every 6 months indefinitely ## Footnote This is classified as BII recommendation.
60
What is the rate of perinatal transmission of HCV for infants born to mothers with HIV?
Approximately 12%.
61
What is the current standard of care for treating HCV infection?
DAA combination therapy.
62
What did a pilot study of ledipasvir/sofosbuvir find regarding pregnant women?
It was safe and resulted in cure in nine women.
63
What should not be used during pregnancy due to teratogenicity concerns?
Ribavirin ## Footnote Ribavirin is an FDA category X drug.
64
What is the recommended treatment for treatment-naive patients without cirrhosis?
* Three (glecaprevir 100 mg/pibrentasvir 40 mg per tablet) tablets daily for 8 weeks (AI) * One (sofosbuvir 400 mg/velpatasvir 100 mg per tablet) tablet daily for 12 weeks (AI)
65
What is the preferred therapy for treatment-naive patients with compensated cirrhosis for genotypes 1, 2, 4–6?
* Three (glecaprevir 100 mg/pibrentasvir 40 mg per tablet) tablets daily for 8 weeks (AIII) * One (sofosbuvir 400 mg/velpatasvir 100 mg per tablet) tablet daily for 12 weeks (AI)
66
What is the alternative therapy for genotype 3 patients?
* Three (glecaprevir 100 mg/pibrentasvir 40 mg per tablet) tablets daily for 12 weeks (CI) * One (sofosbuvir 400 mg/velpatasvir 100 mg per tablet) tablet daily, with or without ribavirin for 12 weeks pending results of NS5A RAS testing (CI)
67
What is the recommended treatment for acute HCV infection?
* Three (glecaprevir 100 mg/pibrentasvir 40 mg per tablet) tablets daily for 8 weeks (AII) * One (sofosbuvir 400 mg/velpatasvir 100 mg per tablet) tablet daily for 12 weeks (AII)

EBAC - Infectious Disease (36 decks)

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