Recommendations for the Treatment of Hepatitis C Virus
the MPR take:
Emerging treatments for hepatitis C virus (HCV) include direct-acting antivirals for the treatment goal of undetectable plasma HCV RNA without concomitant interferon. A new review in the Journal of the American Medical Association assessed the safety and efficacy of FDA-approved interferon-based regimens and oral interferon-free regimens indicated for the treatment of HCV infection and HCV-human immunodeficiency virus (HIV) co-infection for treatment recommendations. Forty-one studies of 19,063 patients were analyzed, with the clinical data strength and subsequent HCV treatment recommendations graded by the Oxford Centre for Evidence-Based Medicine. Because HCV genotype 1 is more difficult to treat vs. genotype 2 or 3, patients with genotype 1 are advised to receive sofosbuvir + pegylated interferon + ribavirin because of high rates of sustained virologic response (SVR) (89%–90%) and shorter duration of treatment. As an alternative, simeprevir + pegylated interferon + ribavirin is also a recommended treatment option (SVR, 79%–86%). For patients with HCV genotypes 2 and 3, sofosbuvir + ribavirin alone is sufficient (SVR for genotype 2, 12 week duration: 82%–93%; SVR for genotype 3, 24 week duration, 80%–95%). Lastly, it is recommended that patients with HIV-HCV coinfection and patients with compensated cirrhosis receive the same treatment as HCV-monoinfected patients.
Importance: Hepatitis C virus (HCV) infects more than 185 million individuals worldwide. Twenty percent of patients chronically infected with HCV progress to cirrhosis. Objectives: To summarize published evidence on safety, efficacy (measured by a sustained virologic response [SVR], which is the ...
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