Fast Five Quiz: Liver Disease

B.S. Anand, MD

Disclosures

August 16, 2019

Please note that guidelines for the current diagnostic workup and management of HCV infection continue to rapidly evolve. Clinicians are advised to refer frequently to the most recent recommendations of the AASLD and IDSA.

The World Health Organization (WHO) recommends the use of pangenotypic direct-acting antiviral agent regimens to treat individuals with chronic HCV infection aged ≥ 18 years. These pangenotypic regimens include glecaprevir-pibrentasvir (noncirrhotic patients, 8 weeks; patients with compensated cirrhosis, 12 weeks), sofosbuvir-daclatasvir (noncirrhotic patients, 12 weeks; patients with compensated cirrhosis, 24 weeks), and sofosbuvir-velpatasvir (noncirrhotic patients or those with compensated cirrhosis, 12 weeks).

WHO recommendations for teens with chronic HCV infection aged 12-17 years or weighing ≥ 77.16 lb (≥ 35 kg) are as follows:

  • Genotype 1, 4, 5, and 6: sofosbuvir-ledipasvir for 12 weeks

  • Genotype 2: sofosbuvir-ribavirin for 12 weeks

  • Genotype 3: sofosbuvir-ribavirin for 24 weeks

In children with chronic HCV infection who are younger than 12 years, the WHO recommends deferring treatment until they are aged 12 years, as well as discontinuing interferon-based regimens.

Because spontaneous resolution of acute HCV infection may occur, monitoring for clearance for a minimum of 6 months before initiating treatment is recommended. Patients with acute HCV infection appear to have an excellent chance of responding to 6 months of standard therapy with interferon. However, interferon-sparing regimens are safer and are currently recommended for the treatment of acute HCV infection, as with chronic HCV infection.

Patients coinfected with HIV and HCV are at risk for accelerated liver fibrosis and should usually be offered antiviral treatment. Persons with HIV/HCV coinfection should be treated and retreated the same as those without HIV infection, once any interactions with antiretroviral agents have been identified and managed. Daily daclatasvir plus sofosbuvir (400 mg), with or without ribavirin, is a recommended regimen when antiretroviral regimen changes cannot be made to accommodate alternative HCV direct-acting antiviral medications. However, the combination of ledipasvir-sofosbuvir for 8 weeks is not recommended, regardless of the patient's baseline HCV RNA level.

Read more about the treatment of HCV infection.

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