Antiviral treatment of Chronic viral hepatitis

Chronic HCV:
Indications:
All patients with HCV infection without limited life-expectancy.
Treatment:
These direct acting antiviral (DAA) options are considered equivalent without any superiority:
 Sofosbuvir/velpatasvir.
 Glecaprevir/pibrentasvir.
 Sofosbuvir/ledipasvir.
 Grazoprevir/elbasvir.
A)patientswithout cirrhosis or with compensated (Child-Pugh A) cirrhosis:

-Fixed-dose combination of sofosbuvir/velpatasvir OR glecaprevir/pibrentasvir for 12 weeks.

-If cirrhosis can be reliably excluded by markers, treated for 8 weeks only.
-Sustained virologic responce 12 weeks after the completion of this treatment (SVR-12) is more than 95%.
-In patients with advanced fibrosis or compensated cirrhosis, surveillance for the diagnosis of HCC must be
provided.
B)patients with decompensated (Child-Pugh B or C) cirrhosis:
-Protease inhibitors (...-previr) are contraindicated.

-A combination of sofosbuvir/velpatasvir OR sofosbuvir/ledipasvir WITH ribavirin for 12 weeks.

-This teatment regimen is repeated after liver transplantation.
Chronic HBV:
Indications:
1. All patients with HBeAg-positive or -negative chronic hepatitis B, defined by:
•HBV DNA > 2,000 IU/ml.
•Elevated ALT.
•At least moderate liver necroinflammation or fibrosis.
2. Patients with HBV DNA > 20,000 IU/ml and ALT > 2xULN regardless of the degree of fibrosis.
3. Patients with compensated or decompensated cirrhosis with any detectable HBV DNA level regardless of
ALT levels.
Treatment:
peg-IFN OR nucleotide analogues (NA) eg. entecavir, tenofovir.
Immune tolerant adults:
tested every 6months to monitor for potential transition to immune-active or immune-inactive.

Source: EASL & AASLD Guidelines 2018.

16 Feb 2020