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Uptodate Reference Title
Antiviral selection for HCV genotype 1 infection in treatment-naïve adults[1]
Antiviral selection for HCV genotype 1 infection in treatment-naïve adults[1]
The preferred and first-line regimen options listed for each patient population are likely of comparably high efficacy. The choice between them is based on potential drug interactions, local availability, and individual financial or insurance limitations. Overall, we favor glecaprevir-pibrentasvir, ledipasvir-sofosbuvir, or sofosbuvir-velpatasvir for their simplicity of administration (once-daily dosing without the need to evaluate for baseline polymorphisms), and extensive data to support their use. Drug interactions are generally manageable but should be evaluated prior to initiation, particularly with NS3/4A protease inhibitor-containing regimens (such as glecaprevir-pibrentasvir).
Doses of direct-acting antivirals are standard. Daclatasvir dose adjustment is warranted with concomitant use of P450 inducers and inhibitors. If ribavirin is used, dosing is weight based: 1000 mg daily if <75 kg and 1200 mg daily if ≥75 kg.
This algorithm does not apply to patients with estimated glomerular filtration rate <30 mL/min per 1.73 m2 (or on dialysis). Refer to UpToDate content on HCV treatment in patients with renal impairment for more details.
HCV: hepatitis C virus; RASs: resistance-associated substitutions. * Ascites, hepatic encephalopathy, prolonged prothrombin time, decreased serum albumin, and/or hyperbilirubinemia. ¶ Treatment with ledipasvir-sofosbuvir for 8 instead of 12 weeks is a highly effective option for treatment-naïve patients without cirrhosis who have a baseline viral level <6 million international units/mL. However, if such patients have negative traditional predictors of treatment response (ie, male sex, obesity, being of a Black population) or HIV infection, we favor treating for 12 weeks if possible. Δ For subtype 1a-infected patients in whom elbasvir is being considered, testing for NS5A RASs should be performed. RASs that confer reduced susceptibility to elbasvir-grazoprevir include polymorphisms at M28, Q30, L31, and Y93. If these are present, the recommended regimen is elbasvir-grazoprevir with ribavirin for 16 weeks. ◊ In the United States, daclatasvir plus sofosbuvir is not approved by the Food and Drug Administration for genotype 1 infection, so it may not be a feasible option for most patients. § If ombitasvir-paritaprevir-ritonavir plus dasabuvir is used in patients with cirrhosis, close monitoring for hepatic decompensation is warranted. This regimen is contraindicated in patients with Child-Pugh classes B and C cirrhosis.
Reference:
AASLD-IDSA. Recommendations for testing, managing, and treating hepatitis C. Available at: http://www.hcvguidelines.org (Accessed on August 23, 2017).
