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BCPS study guide

Hepatitis C

definition of chronic HCV infection presence of viral RNA in serum for 6 months or more
RVR Rapid virological response - undetectable HCV RNA at week 4 of treatment
EVR Early virological response - >2 log reduction in HCV RNA compared with baseline or undetectable HCV RNA at 12 weeks
ETR end of treatment response - undetectable HCV RNA at the end of a 24 or 48 week course, depending on genotype
SVR sustained virologic response - undetectable HCV RNA 24 weeks after finishing treatment
recommended initial treatment for acute infection interferon preferably PEG interferon. treat for 12-24 weeks. may add ribavirin but not proven to improve SVR. alternatively can wait to see if pt has spontaneous resolution.
treatment goal for treatment of acute infection vs chronic infection for acute goal is to prevent chronic infection. for chronic infection goal is to achieve SVR
ADEs associated with ribavirin hemolytic anemia - requires dose adjustment and may require colony stimulating factors. riba rage, pancreatitis, pulmonary toxicity, insomnia, irritability. preggers category X.
treatment of chronic HCV infection. ribavirin and protease inhibitors. or NS5B polymerase inhibitor ex. sofosbuvir (Sovaldi) but depends on genotype. now sofosbuvir in all first line treatments
genotype 1 HCV treatment - first line interferon/ribavirin and sofosbuvir or sofosbuvir, ribavirin and simeprevir. treat for 12 weeks
genotype 2/3 HCV treatment - first line sofosbuvir + ribavirin type 2 treat for 12 weeks, type 3 treat for 24 weeks
genotype 4 HCV treatment - first line interferon/ribavirin and sofosbuvir and treat for 12 weeks or sofosbuvir and ribavirin treat for 24 weeks
genotype 5/6 HCV treatment - first line sofosbuvir and peg/ribavirin for 12 weeks
the new AASLD/IDSA guidelines have removed the previous protease inhibitor therapies in favor of sofosbuvir but if genotype I pts were already on these treatment regimens prior to 2014 guidelines what should guide therapy? HCV RNA at wks 4 and 24. if undetectable in most cases continue trt and extend for up to 48 wks depending on whether pt is trt naive or previously responded or relapsed. if HCV RNA >100 at wk 12 or detectable at wk 24 d/c all three drugs if bocepravir
Created by: mjuhlin