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Hepatitis C Updated Treatment Protocol
By:-
Sayed Hanzal Ass. Lecturer of Hepatogastroenterology
fayoum univ.
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5 Questions …..???
1) Why should we treat HCV ?2) Endpoint of therapy ??3) Drugs available and it’s mech. ???4) Egyptian guidelines for HCV ttt ?????
Amazing patient’s questions
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Why should we treat HCV ?80 million people are chronically infected worldwide (3%)
More then 350 000-500 000 people die every year from Hepatitis C related end-stage liver disease (cirrhoses, HCC,
liver failure)
3-4 million people become infected with HCV annually
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HCV in Egypt• Prevalence : 7%• Total number of cases: 6 million• Number of patients aware of infection:
1million• Number of yearly new diagnosed cases :
120,000• Newly yearly infected cases:
120,000 – 150,000
• Number of yearly liver cancer cases caused by HCV : 16,000
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Endpoint of therapy
• undetectable HCV RNA 12 weeks (SVR12) and 24 weeks (SVR24) after the end of treatment
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Drugs available and there mech. ????
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HCV Life Cycle and DAA Targets
Adapted from Manns MP, et al. 2007
Transportand release
(+) RNA
Translation andpolyprotein processing RNA replication
Virionassembly
NS3/4A protease inhibitors
NS5B polymerase inhibitors
NS5A inhibitors
“Previr’s” Boceprevir, Telaprevir, Simeprevir, Faldaprevir
“Buvir’s” Sofosbuvir, Deleobuvir
“Asvir’s” Daclatasvir, Ledipasvir
DAA
Uncoating
Receptor binding
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Egyptian guidelines for HCV ttt ?????
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• All PCR +ve , ≥ 18 years except 1. Child C2. Plt < 503. HCC, except 6 months after cure with no
evidence of activity by dynamic (CT or MRI).4. Extra-hepatic malignancy except after two years
of disease-free interval except lymphomas5. Pregnancy6. (HbA1c>9 %)
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Prvious ttt with DAAs
naive
easy difficult
experienced
Sof +dac Sof +sim
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DAAs naïve (12Ws)
Easy to treat group:
• Treatment naïve • Total s. bil ≤ 1.2 mg/dl. • S. albumin ≥ 3.5 g/dl. • INR≤ 1.2. • Platelet ≥150.000/mm3.
Difficult to treat group:
• Peg-IFN ttt experienced • Total s. bil >1.2 mg/dl. • S. albumin <3.5 g/dl. • INR>1.2. • Platelet <150.000/mm3.
SOF/DAC orQurevo/RBV SOF/DAC/RBV
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DAAs experience (12Ws)RBV ineligible: extend (24 Ws)
• SOF/Qurevo/RBV ORSOF/SIM/DAC/RBV
• Child’s B (specialized centers)
SOF/DAC/RBV for 24Ws.
• SOF/DAC/RBV
SOF/DAC FailureSOF/SIM Failure
Ribavirin dose : 1000 mg <75 kg. 1200 mg >75 kg
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CKD according to eGFR
• eGFR > 30 ml/min
by the usual ttt regimens
• eGFR ≤ 30 ml/min
Qurevo/RBVIn the conition that
Child A or no cirrhosisHb at least 10 g/dLno uncont. co-morbidityA nephrologist consult
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post organ transplantation
SOF/DAC/RBV for 24Ws
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Combined HCV and HBV
• treated with the same regimens
If HBV replicates at significant levels before, during or after HCV clearance,
concurrent HBV therapy is indicated.
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Amazing patient’s questions
• Did hcv reach my liver• Does hcv affect liver only • Does ttt curative or suppresive to the virus• What about relapse • Are there follow up after end of ttt (if there ,whome
and how) • possibilty of Re-infection • What about hcv antibodies (presence ,
risk ,clearance )
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