Podcast
Questions and Answers
Which professional works primarily with patients with viral hepatitis, HIV, those on HIV PrEP, and those with other complex infections?
Which professional works primarily with patients with viral hepatitis, HIV, those on HIV PrEP, and those with other complex infections?
- Ambulatory Care Residency Graduate
- Infectious Disease Specialist
- Community Residency Graduate
- Clinical Pharmacy Specialist (correct)
What type of residency training did the person who graduated from University of Health Sciences and Pharmacy ('18) complete?
What type of residency training did the person who graduated from University of Health Sciences and Pharmacy ('18) complete?
- PGY-2 Community Residency
- PGY-1 Community Residency
- PGY-2 Ambulatory Care Residency (correct)
- PGY-1 Ambulatory Care Residency
Where can one find the Hepatitis C Treatment Guidelines resource?
Where can one find the Hepatitis C Treatment Guidelines resource?
- <a href="https://www.hep-druginteractions.org/">https://www.hep-druginteractions.org/</a>
- <a href="https://www.hcvguidelines.org/">https://www.hcvguidelines.org/</a> (correct)
- <a href="https://www.infectiousdiseasepharmacyresources.com/hepatitis-c-treatment-guidelines">https://www.infectiousdiseasepharmacyresources.com/hepatitis-c-treatment-guidelines</a>
- <a href="https://www.vumc.org/hepatitis-c-treatment-guidelines">https://www.vumc.org/hepatitis-c-treatment-guidelines</a>
What is the primary focus of the University of Liverpool Drug Interaction Database?
What is the primary focus of the University of Liverpool Drug Interaction Database?
Which individual listed has no disclosures or acknowledgements?
Which individual listed has no disclosures or acknowledgements?
What is the main focus area within the Infectious Diseases Clinic at VUMC where Dr. Muscarella works?
What is the main focus area within the Infectious Diseases Clinic at VUMC where Dr. Muscarella works?
What is the recommended action for individuals with risk factors such as being sexually active, having tattoos, or using illicit drugs?
What is the recommended action for individuals with risk factors such as being sexually active, having tattoos, or using illicit drugs?
Which test is used to diagnose active HCV infection?
Which test is used to diagnose active HCV infection?
What is the primary consideration in choosing the treatment for HCV?
What is the primary consideration in choosing the treatment for HCV?
What are the common long-term complications associated with HCV?
What are the common long-term complications associated with HCV?
Which scores are used to assess liver dysfunction and predict prognosis in patients with HCV?
Which scores are used to assess liver dysfunction and predict prognosis in patients with HCV?
What is an important consideration in the evaluation and treatment of HCV?
What is an important consideration in the evaluation and treatment of HCV?
What is a common cause of cirrhosis?
What is a common cause of cirrhosis?
What does decompensated cirrhosis refer to?
What does decompensated cirrhosis refer to?
What is a primary factor in hepatitis C treatment selection?
What is a primary factor in hepatitis C treatment selection?
What tests need to be completed before initiating antiviral therapy for hepatitis C?
What tests need to be completed before initiating antiviral therapy for hepatitis C?
How long does the treatment duration typically last for hepatitis C?
How long does the treatment duration typically last for hepatitis C?
What are the targets for hepatitis C drug therapy?
What are the targets for hepatitis C drug therapy?
What is one of the leading causes of hepatitis C transmission?
What is one of the leading causes of hepatitis C transmission?
Which organization reported on Medicaid prescribing restrictions in their 2023 National Progress Report?
Which organization reported on Medicaid prescribing restrictions in their 2023 National Progress Report?
What can treating hepatitis C help to reduce?
What can treating hepatitis C help to reduce?
Which of the following activities or exposures is considered a risk factor for HCV infection?
Which of the following activities or exposures is considered a risk factor for HCV infection?
Who provides helpful course modules and overviews of all hepatitis C medications?
Who provides helpful course modules and overviews of all hepatitis C medications?
What is the recommended testing approach for individuals at risk of HCV infection according to the AASLD/IDSA Hepatitis C Treatment Guidelines?
What is the recommended testing approach for individuals at risk of HCV infection according to the AASLD/IDSA Hepatitis C Treatment Guidelines?
What are the secondary factors in HCV treatment selection?
What are the secondary factors in HCV treatment selection?
Which side effects are commonly associated with DAAs (Direct-acting antivirals)?
Which side effects are commonly associated with DAAs (Direct-acting antivirals)?
Which HCV genotypes have recommended regimens including glecaprevir/pibrentasvir (G/P)?
Which HCV genotypes have recommended regimens including glecaprevir/pibrentasvir (G/P)?
Which regimen must be taken with food?
Which regimen must be taken with food?
What is the recommended treatment duration for genotype 4 with cirrhosis?
What is the recommended treatment duration for genotype 4 with cirrhosis?
For which patient types is resistance testing recommended?
For which patient types is resistance testing recommended?
Which formulation is available for ribavirin?
Which formulation is available for ribavirin?
What is the starting weight-based dosing for ribavirin?
What is the starting weight-based dosing for ribavirin?
What is a contraindication for ribavirin?
What is a contraindication for ribavirin?
Which treatment option is suitable for ribavirin-eligible patients with genotypes 1-6?
Which treatment option is suitable for ribavirin-eligible patients with genotypes 1-6?
In which special population is treatment not recommended at this time?
In which special population is treatment not recommended at this time?
What should be evaluated prior to starting treatment?
What should be evaluated prior to starting treatment?
Which medication class requires caution and management based on drug classes and individual circumstances when used in combination with DAAs?
Which medication class requires caution and management based on drug classes and individual circumstances when used in combination with DAAs?
"Treating decompensated cirrhosis: Protease inhibitors are contraindicated." What should be done for patients with CTP Class B or C and/or MELD >10?
"Treating decompensated cirrhosis: Protease inhibitors are contraindicated." What should be done for patients with CTP Class B or C and/or MELD >10?
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Study Notes
- Ribavirin is not suitable for monotherapy and must be used in combination with other Direct-Acting Antivirals (DAAs).
- The formulation is available as 200 mg tablets or capsules, with weight-based dosing starting at 600 mg and potentially increasing to 1200 mg. Dose reductions may be needed for renal impairment.
- Ribavirin must be taken with food and is contraindicated in pregnancy, with patients required to have negative pregnancy tests prior to therapy and use contraception.
- Frequent monitoring is necessary due to hemolytic anemia risk and gastrointestinal side effects.
- Treatment options include ledipasvir/sofosbuvir + ribavirin for 12 weeks or sofosbuvir/velpatasvir + ribavirin for 12 weeks for ribavirin-eligible patients with genotypes 1-6.
- For ribavirin-ineligible patients with genotypes 1-6, ledipasvir/sofosbuvir can be used for 24 weeks or sofosbuvir/velpatasvir for 24 weeks.
- Treating decompensated cirrhosis: Protease inhibitors are contraindicated. Treatment decisions should be made in collaboration with experts at liver transplant centers for patients with CTP Class B or C and/or MELD >10.
- Special populations include chronic kidney disease (no dose adjustment needed with DAAs), HIV co-infection (treatment not recommended at this time), and children (testing requirements after birth if born to HCV+ mother, medications approved for age >3 if treatment required).
- Hepatitis C and incomplete adherence: Adherence is crucial. Missed doses should be addressed with the patient, and treatment may need to be re-initiated.
- Prior to starting treatment, potential drug-drug interactions should be evaluated by consulting prescribing information and other resources.
- Drug-drug interactions: Certain medications (antacids, H2RAs, PPIs, ART regimens containing protease inhibitors, cobicistat, ritonavir, amiodarone/dronedarone, anticonvulsants, statins, oral anticoagulants, and hormone therapies) require caution and management based on drug classes and individual circumstances.
- Green flag medication classes: Certain medications (pain medications, benzodiazepines, diabetes medications, SSRIs, SNRIs, mirtazapine, MAT, antibiotics used for STIs, uncomplicated URIs, or SSTIs) are generally safe to use in combination with DAAs.
- Ledipasvir/sofosbuvir, sofosbuvir/velpatasvir, and glecaprevir/pibrentasir interact with PPIs, H2RAs, and antacids, with doses equivalent to pantoprazole 40 mg daily.
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