hepatitis C virus Monitoring on Rx

• prior to starting Rx.

  • CBC,
  • INR,
  • LFTs,
  • GFR,
  • HCV VL

• PIs contraindicated if decomp. liver dx (ascites, encephalopathy) or CPS ≥7.

• D/c Rx if:

  • jaundice,
  • N/V,
  • weakness,
  • 10x ↑ in ALT,
  • or significant ↑ in bili,
  • Aϕ,
  • INR after 4 wks.

• Goal is → sustained virologic response (SVR) = Ø viremia 12 wks after completion of Rx. Success depends on genotype but SVR rates >90% with current regimens.

• Special populations (HCV/HIV coinfection, decompensated cirrhosis, s/p liver transplant, renal impairment): <www.hcvguidelines.com> for updated recs on mgmt

• Vaccinate all chronic HCV patients against HBV and HAV if not immune

• Postexposure (needlestick risk ~3%) Ppx: none, although sofosbuvir-velpatasivir under investigation in clinical trial; if HCV RNA → ⊕, consider Rx w/in 3 mos