Skill Checkup: A Man With Itching and Abdominal Pain 

Alastair O'Brien, MBBS, BSc, PhD


March 18, 2021

EASL guidelines list four DAA regimens for the treatment of chronic HCV genotype 1a infection : sofosbuvir/velpatasvir, glecaprevir/pibrentasvir, sofosbuvir/ledipasvir, and grazoprevir/elbasvir. The recommendation for sofosbuvir/ledipasvir in this setting is limited to treatment-naive patients; the recommendation for grazoprevir/elbasvir is limited to patients with HCV RNA ≤ 800,000 IU/mL.

Pangenotypic DAA combination regimens approved by the European Medicines Agency and the FDA include sofosbuvir/velpatasvir, sofosbuvir/velpatasvir/voxilaprevir, and glecaprevir/pibrentasvir. These regimens are also approved for patients with HCV/HIV coinfection and cirrhosis.

The EASL guidelines recommend the use of pangenotypic DAA-based regimens that are IFN-free and ribavirin-free because of their efficacy, safety, and tolerability. These regimens are preferred in HCV-infected patients without cirrhosis or with compensated cirrhosis, including ‘treatment-naive’ patients and ‘treatment-experienced’ (patients who were previously treated with PEG-IFN-alpha and ribavirin; or PEG-IFN-alpha, ribavirin and sofosbuvir; or sofosbuvir and ribavirin).

Per the EASL guidelines, ribavirin is generally reserved for treatment of chronic HCV infection as part of combination antiviral therapy in certain patients with decompensated cirrhosis and/or failure of two or more lines of DAA-based treatment due to NS5A resistance-associated substitutions.

EASL recommends that all patients with HCV infection should be tested for past or current HBV infection, HIV infection, and for immunity to HAV. This patient tested negative for HIV, HBV, and HAV.


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