How is hepatitis C virus (HCV) (HIV) infection treated in HIV infection?
Antiretroviral treatment for HIV may slow the progression of HCV-related liver disease and reduce the risk of liver-related morbidity. For all persons with HIV-HCV coinfection, antiretroviral therapy should be initiated to treat HIV, regardless of the CD4 cell count and fibrosis stage.
What if initial HCV treatment fails to achieve cure (SVR)?
Patients in whom initial HCV treatment fails to achieve cure (SVR) should be evaluated for retreatment by a specialist, in accordance with AASLD/IDSA guidance.
What factors influence the choice of treatment for hepatitis C virus (HCV)?
For individuals with chronic HCV genotype 1 infection, the main factors that influence the choice and duration of therapy are cirrhosis status and prior treatment experience.
What should I expect during treatment for hepatitis C virus (HCV)?
All patients should have access to an HCV care provider during treatment, although preset clinic visits and/or blood tests depend on the treatment regimen and may not be required for all regimens/patients. Patients receiving ribavirin require additional monitoring for anemia during treatment (see Monitoring section).
How do you decide on the most effective treatment for hepatitis?
Your doctor determines the specific medication or medications that are likely to be most effective for you based on which genotype of hepatitis C you have, whether there is scarring of the liver, and whether you have taken antiviral medication previously.
Which HCV is better response for treatment?
Hepatitis C virus (HCV) genotype 2a has a better virologic response to antiviral therapy than HCV genotype 1b - PMC. The . gov means it's official. Federal government websites often end in .
What are the factors that need to be considered before the specific HCV treatment?
Pre-treatment assessment.Perform a virological evaluation.Evaluate for the presence of cirrhosis.Consider whether there is HBV or HIV coinfection or coexisting liver disease present.Consider concomitant medications for risk of drug–drug interactions.Adherence to treatment.Consensus recommendations.
What is recommended treatment for a patient who is treatment naïve and does not have cirrhosis?
Treatment-Naive Genotype 1a Patients Without Cirrhosis Dosing is 3 coformulated tablets (glecaprevir [100 mg]/pibrentasvir [40 mg]) taken once daily.
When do you recheck Hep C after treatment?
It is essential to test for HCV RNA 12 weeks (or longer) after treatment completion. Undetectable or unquantifiable HCV RNA 12 weeks or longer after treatment completion is defined as a sustained virologic response (SVR), which is consistent with cure of chronic HCV infection.
Do you still test positive for hep C after treatment?
Other things to know: After a successful course of treatment for hepatitis C, the hepatitis C antibody remains detectable, but the hepatitis C RNA will be undetectable. If you plan to donate blood, you will be tested for the hepatitis C antibody and will be turned away even if you do not have an active infection.
What is the most commonly recommended treatment protocol for HCV?
Hepatitis C is treated using direct-acting antiviral (DAA) tablets. DAA tablets are the safest and most effective medicines for treating hepatitis C. They're highly effective at clearing the infection in more than 90% of people. The tablets are taken for 8 to 12 weeks.
What are contraindications for treatment of HCV?
Many autoimmune conditions (e.g., systemic lupus erythematosus, rheumatoid arthritis, autoimmune hepatitis, psoriatic arthritis) are contraindications to the use of combination drug therapy for HCV infection.
What can cause a hep C false positive?
Causes of a false-positive hepatitis C test You may receive a false-positive result if your antibodies are triggered by another infection. People who've recovered from hepatitis C on their own may also get a false-positive anti-HCV test result. In rare cases, lab error leads to a false positive.
What are treatment naive patients?
A person is considered to be "treatment-naive" if they have never undergone treatment for a particular illness. 1 In the world of sexually transmitted infections (STIs), the term is most often used to refer to people who are HIV-positive and who have never taken any antiretroviral therapy for their infection.
Which HCV genotype is easiest to treat?
In the United States, hepatitis C genotype 3 is less commonly contracted than genotype 1, but genotype 3 is also harder to treat....Genotype 3 has been found to respond better to newer drug combinations, including:glecaprevir-pibrentasvir (Mavyret)sofosbuvir-velpatasvir (Epclusa)daclatasvir-sofosbuvir (Sovaldi)
Do you treat asymptomatic hep C?
Acute HCV infections are usually asymptomatic and most do not lead to a life-threatening disease. Around 30% (15–45%) of infected persons spontaneously clear the virus within 6 months of infection without any treatment.
What is the first treatment for HCV?
Initial treatment of HCV infection includes patients with chronic hepatitis C who have not been previously treated with interferon, peginterferon, ribavirin, or any HCV direct-acting antiviral (DAA) agent, whether investigational, or US Food and Drug Administration (FDA) approved .
How are recommended and alternative regimens listed?
Recommended and alternative regimens are listed in order of level of evidence. When several regimens are at the same recommendation level, they are listed in alphabetical order. Regimen choice should be determined based on patient-specific data, including drug-drug interactions.
What is recommended regimen?
Recommended regimens are those that are favored for most patients in a given group, based on optimal efficacy, favorable tolerability and toxicity profiles, and treatment duration.
What is an alternative regimen?
Alternative regimens are those that are effective but, relative to recommended regimens, have potential disadvantages, limitations for use in certain patient populations, or less supporting data than recommended regimens.
What are the factors that influence the choice of treatment for HCV?
For treatment-naïve adults with chronic HCV genotype 1 infection, the main factors that influence the choice and duration of therapy are (1) presence or absence of cirrhosis, and (2) medication cost or insurance considerations. In the case of elbasvir-grazoprevir use, the HCV genotype 1 subtype (1a or 1b) is also important, as the presence of specific baseline NS5A RASs significantly reduces SVR12 rates in persons with HCV genotype 1a. [ 10, 11, 12] In cases where the genotype 1 subtype is not known, the individual should be treated as HCV genotype 1a. The baseline HCV RNA level generally does not influence the treatment choice or duration, except in treatment-naïve noncirrhotic patients in whom 8 or 12 weeks of ledipasvir-sofosbuvir is being considered. [ 13] Additional data from the HCV-TARGET registry and the Veterans Affairs National Healthcare System demonstrated comparable SVR rates of 94 to 98% for adults without cirrhosis treated with either 8 or 12 weeks of ledipasvir-sofosbuvir if the baseline HCV RNA levels were less than 6 million IU/mL. [ 14, 15, 16] In addition to the factors noted above, drug interactions may also influence the choice of therapy, particularly for individuals with HIV coinfection who are taking antiretroviral medications. Of note, individuals with HCV and HIV coinfection, depending on their specific antiretroviral therapy, are eligible for most of the same regimens for initial treatment of genotype 1 as for persons with HCV monoinfection, except that persons with HIV should not receive (1) any 8-week option of ledipasvir-sofosbuvir, or (2) the 8-week option of glecaprevir-pibrentasvir if cirrhosis is present. [ 11, 12, 17, 18]
What are the factors that affect the choice of treatment for HCV genotype 1?
For individuals with chronic HCV genotype 1 infection, the main factors that influence the choice and duration of therapy are cirrhosis status and prior treatment experience . With the use of certain regimens for persons with HCV genotype 1a, namely elbasvir-grazoprevir, the genotype 1 subtype (1a or 1b) also impacts the choice of therapy, as elbasvir-grazoprevir is only recommended for persons with HCV genotype 1a who do not have baseline NS5A resistance-associated substitutions (RASs). In addition, the HCV RNA level and the patient’s HIV status can impact the duration of ledipasvir-sofosbuvir, but does not affect the duration of other regimens. Finally, the cost of the regimen, insurance coverage, and provider preference can play a major role in the regimen choice. The following treatment recommendations are based on the AASLD-IDSA HCV Guidance for initial treatment of adults with HCV genotype 1 and for retreatment of adults in whom prior therapy failed, including those with HCV genotype 1. [ 4, 5]
What is the AASLD-IDSA HCV guidance?
The following is a summary of the AASLD-IDSA HCV Guidance for adults with HCV genotype 1 infection who are treatment experienced and failed prior DAA therapy , including those without cirrhosis and those with compensated cirrhosis. [ 5, 28, 29, 30] For individuals with cirrhosis, the AASLD-IDSA HCV Guidance defines compensated cirrhosis as Child-Turcotte-Pugh class A and decompensated cirrhosis as Child-Turcotte-Pugh class B or class C. The AASLD-IDSA HCV Guidance for retreatment is no longer genotype specific, but instead emphasizes a pangenotypic approach to retreatment based on the prior treatment regimen. In addition, the AASLD-IDSA HCV Guidance no longer includes recommendations for the retreatment of persons who experienced prior treatment failure with interferon-based therapy, including interferon plus first-generation protease inhibitors ( telaprevir, boceprevir ); these individuals have robust cure rates with modern DAA regimens similar to that observed with treatment-naïve persons. The recommended regimens in the tables below are based on prior regimen failure and listed by evidence level; when the evidence level is considered equivalent, the regimens are listed alphabetically.
Why do you need to monitor after antiretroviral therapy?
Because of the increased risk of hepatoxicity after initiating antiretroviral therapy in persons with HCV confection, the Adult and Adolescent ARV Guidelines recommend the following monitoring after initiating antiretroviral therapy in persons with HCV-HIV coinfection. [ 33]
What is the AASLD-IDSA HCV guidance?
The AASLD-IDSA HCV Guidance addresses treatment of persons with HCV and HIV coinfection in detail. [ 13] The AASLD-IDSA HCV Guidance recommends using the same general approach for treating HCV in persons with HCV-HIV coinfection as with HCV monoinfection, but notes the importance of recognizing and managing potential drug interactions between HCV medications and HIV antiretroviral medications. [ 13] In most instances, the AASLD-IDSA HCV Guidance recommends using the same HCV treatment regimens and duration for persons with HCV-HIV coinfection as for those with HCV monoinfection, with several exceptions, as outlined below, that require a longer treatment duration for persons with HCV-HIV coinfection than those with HCV monoinfection due to insufficient data on the efficacy of these 8-week regimens among individuals with coinfection. [ 13]
What is glecaprevir pibrentasvir?
Glecaprevir-Pibrentasvir: Glecaprevir is a substrate of OATP1B1/3, p-glycoprotein (P-gp) and breast cancer resistance protein (BCRP), as well as an inhibitor of these transporters. The levels of glecaprevir are increased when used with the HIV protease inhibitors atazanavir, lopinavir, or ritonavir. [ 38] .
Does HIV accelerate hepatic fibrosis?
In persons with chronic HCV, coinfection with HIV accelerates the progression of hepatic fibrosis. Therefore, treatment of both HIV and HCV should have high priority in persons with HIV-HCV coinfection.
Is glecaprevir a contraindication?
Glecaprevir-pibrentasvir is contraindicated for use with atazanavir (with or without ritonavir or cobicistat). In addition, glecaprevir-pibrentasvir is not recommended for coadministration with darunavir, lopinavir, tipranavir, ritonavir, efavirenz, etravirine, or nevirapine.
Can you use ledipasvir with cobicistat?
Because of this concern and lack of data, the use of ledipasvir with the combination of tenofovir DF and cobicistat- or ritonavir-boosted HIV protease inhibitors should, if possible, be avoided. For similar reasons, ledipasvir-sofosbuvir should not be used with cobicistat, elvitegravir, or tipranavir.
Is liver biopsy required for hepatitis C?
Adults with chronic hepatitis C (any genotype) who have compensated cirrhosis (Child-Pugh A) and have not previously received hepatitis C treatment. Liver biopsy is not required. For the purpose of this guidance, a patient is presumed to have cirrhosis if they have a FIB-4 score >3.25 or any of the following findings from a previously performed ...
Should patients with HCV be tested for RNA?
Patients with ongoing risk for HCV infection (eg, intravenous drug use or MSM engaging in unprotected sex) should be counsel ed about risk re duction, and tested for HCV RNA annually and whenever they develop elevated ALT, AST, or bilirubin. Patients should abstain from alcohol to avoid progression of liver disease.