Hep C & B

First line DAA for TX naive patients(Hep C)

Glecaprevir/ Pibrentasvir (Mavyret)

Sofosbuvir/Velpatasvir(Epclusa)

Epclusa components

Sofosbuvir/Velpatasvir

Mavyret components

Glecaprevir/pibrentasvir

NS3/4A protease inhibitors

• Glecaprevir
• Grazoprevir
• Voxilaprevir

P for PI

NS5A replication complex inhibitors

Elbasvir
• Ledipasvir
• Pibrentasvir
• Velpatasvir

A for NS5A

NS5B polymerase inhibitors

• Sofosbuvir

B for NS5B

BW for all DAA's

Risk of reactivating HBV so need to test all pts before starting therapy

What medication can cause serious symptomatic bradycardia if taken with amiodarone? (HCV)

Sofosbuvir containing regimens!!
• Epclusa, Harvoni, Vosevi

Mavyret DDI

Select statins: (ASL - atorva, simva, lova)

All DAA should avoid strong CYP3A4

inducers(PS-PORCS)

Antacids, H2RA, & PPIs can decrease concentrations of ________ and _______

ledipasvir and velpatasvir

Ribavirin BW

• Significant teratogenicity (use 2 forms of contraception during TX and for 6-9 months after)
• Monotherapy not effective for HCV
• Hemolytic anemia

Ribavirin can cause teratogenicity so need ≥2 forms of effective contraception during TX and for ___-___ months after.

6-9 months

HBV TX options

• First line: NRTI
• Alterative: pegylated interferon alfa-2a

What is the TX of choice if a patient is coinfected with HIV and HBV?

Two NRTI's

What is recommended as monotherapy for HBV

• Entecavir(baraclude)
• TDF(Viread)
• TAF(vemlidy)

NRTI's BW

• Exacerbation of HBV
• Lactic acidosis & severe hepatomegaly with steatosis

Entecavir & TDF need renal dose adjustments with CrCl < __ mL/min

50

TDF & TAF adverse effects

• Nausea
• Diarrhea
• Lipid abnormalities with TAF

T/F: Viread and Vemlidy should be dispensed in OG container

True

How should entecavir be taken with regards to food?

On an empty stomach

Pegasys BW

Can cause or exacerbate neuropyschiatric, autoimmune, ischemic, or infectious disorders

Pegasys adverse effects

• Myelosuppression
• CNS effects (fatigue, depression)
• GI upset
• Increased LFT's (5-10x ULN)
• Flu like syndrome (fever, chills, HA, malaise) - pretreat with APAP & antihist

How is pegasys administered?

SQ