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Antiviral selection for HCV genotype 3 infection in adults[1]

Antiviral selection for HCV genotype 3 infection in adults[1]
  • The options listed for each patient population are likely of comparable high efficacy. The choice among them is based on potential drug interactions, patient preference regarding dosing, local availability, and individual financial or insurance limitations.
  • 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.
¶ If glecaprevir-pibrentasvir is definitely to be used, NS5A RAS testing is not necessary. If NS5A RAS testing is not available and a sofosbuvir-velpatasvir or daclatasvir plus sofosbuvir regimen is chosen, we favor adding ribavirin (or selecting sofosbuvir-velpatasvir-voxilaprevir or glecaprevir-pibrentasvir).
Δ​ In locations where fixed combination regimens are available, daclatasvir plus sofosbuvir does not offer an advantage and is likely more costly or difficult to access. However, it is the main option in many resource-limited settings.
Reference:
  1. AASLD-IDSA. Recommendations for testing, managing, and treating hepatitis C. http://www.hcvguidelines.org. Accessed August 23, 2017.
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