Regimen selection for initial therapy of chronic HCV infection

This algorithm reflects our approach to initial therapy, for which we prioritize simplifying care to reduce barriers to access. The measured outcome of therapy is SVR, which is defined as an undetectable HCV viral level 12 weeks after the completion of therapy and reflects effective cure of infection. For additional details, including the evidence supporting this approach, refer to other UpToDate content on treatment of chronic HCV infection.

SVR: sustained virologic response.

* For initial therapy, knowledge of the HCV genotype and stage of fibrosis is not essential to selecting an antiviral regimen, as the preferred options are highly effective for all patients, regardless of genotype and cirrhosis. However, if these results are already available or if obtaining them does not pose a potential barrier to treatment, the information can be used to tailor regimen selection for a small subset of patients, which may increase their likelihood of SVR by a few percentage points.

¶ In patients with genotype 3 and cirrhosis, testing for the Y93H NS5A resistance-associated substitution is used to guide the optimal sofosbuvir-velpatasvir-based regimen. Because this testing is not always readily available, we generally favor glecaprevir-pibrentasvir for such patients. Refer to other UpToDate content for more details.

Δ The selection between sofosbuvir-velpatasvir and glecaprevir-pribrentasvir is often dictated by access (eg, payers may only reimburse one of the options). If both are accessible, the choice between them depends on the potential for drug interaction and patient preference regarding practical administration issues.

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Regimen selection for initial therapy of chronic HCV infection