High Points

Monitoring to do ≤6 months prior to initiating hepC therapy:

• AST/ALT, albumin, bilirubin, alkaline phosphatase — hepatic function panel

• eGFR

• CBC

• INR

Monitoring to do any time prior to initiating hepC therapy

• Quantitative/qualitative HCV RNA (for viral load)

• IF non-pangenotypic regimen: genotype testing

• IF able to have children: pregnancy

Characteristics of patients without cirrhosis eligible for simplified therapy

• Treatment-naive

Characteristics of patients with compensated cirrhosis eligible for simplified therapy

• Treatment-naive

Difference in monitoring between patients without cirrhosis and patients with compensated cirrhosis, prior to starting hepC treatment?

• None, except parameters that must be checked ≤6 months of initiating treatment in patients with no cirrhosis must be checked ≤3 months of initiating treatment in patients with compensated cirrhosis

Monitoring to do for patients with decompensated cirrhosis who are ribavirin-eligible

• Pregnancy

• Hypersensitivy to ribavirin

• Current anemia

• Renal dysfunction

  • If ribavirin capsules — GFR <50 mL/min, CI and do not use

  • If ribavirin tablets — GFR <50 mL/min, dose reduce

Monitoring to do during hepC treatment

• If taking diabetes medications — blood sugar for hypoglycemia

• If taking warfarin — INR for subtherapeutic levels

• Otherwise — no monitoring

Monitoring to do after hepC treatment

• Quantitative HCV RNA (viral load, confirm undetectable) ≥12 weeks after treatment end

• Hepatic function panel

What genotype of HCV requires genotype testing for which specific gene, and in what sort of patient?

Genotype 3, for NS5A resistance — Y93H gene (patients with these gene must go to specialized therapy)

• Patient with compensated cirrhosis