Elbasvir-Grazoprevir Zepatier
Glecaprevir-Pibrentasvir Mavyret
Ledipasvir-Sofosbuvir Harvoni
Ribavirin Copegus, Rebetol, Ribasphere
Sofosbuvir Sovaldi
Sofosbuvir-Velpatasvir Epclusa
Sofosbuvir-Velpatasvir-Voxilaprevir VoseviManagement of patients with a lapse in antiviral therapy
May 24, 2022
Clinical Challenge
A 42-year-old man with a history of injection drug use returns to clinic for follow-up of genotype 1a chronic hepatitis C virus (HCV). He was started on glecaprevir-pibrentasvir 6 weeks ago. His pre-treatment HCV RNA level was 12,453 IU/mL and pre-treatment FibroScan showed F0-F1 fibrosis. Today he tells you that he completed 4 weeks of direct acting antiviral (DAA) therapy but failed to pick up his second month of medications from the pharmacy. He has been off glecaprevir-pibrentasvir for 2 weeks now. You check a repeat HCV RNA level, and it returns at 25 IU/mL.
What do you recommend with regards to ongoing DAA therapy?
x 2
Restart glecaprevir-pibrentasvir now and treat for another 4 weeks
45%
Restart glecaprevir-pibrentasvir now and treat for another 8 weeks
45%
Retreat him with 12 weeks of sofosbuvir-velpatasvir-voxilaprevir
9%
Another option not listed above
2%
Results are based on 58 responses from our registered members.
Expert Opinions
Paula P. Cox-North, PhD, MN, ARNP
Hepatitis and Liver Clinic
Harborview Medical Center
University of Washington
Hepatitis and Liver Clinic
Harborview Medical Center
University of Washington
Disclosures
Disclosures for Paula P. Cox-North, PhD, APRN
Speaking Fee: Gilead Sciences
Speaking Fee: Gilead Sciences
Opinion submitted
Restart glecaprevir-pibrentasvir now and treat for another 4 weeks
He took 28 days of therapy and has now been off for 14 days. An HCV RNA was done that showed a level of 25IU/mL, which is the cutoff point for a negative test, so I would consider this a negative HCV RNA result. Since he has been off for 2 weeks and still has a negative HCV RNA, with genotype 1a HCV and minimal fibrosis, I would restart medication and have him finish out the planned 8 week treatment regimen.
If his viral load was >25 IU/mL, or he had HCV genotype 3, or had cirrhosis, or if I did not have repeat HCV RNA results, then I would treat him for another 8 weeks rather than 4 weeks.