EASL RECOMMENDATIONS ON THE

TREATMENT OF HEPATITIS C

PAKISTAN HAS 2ND HIGHEST PREVALENCE OF HCV IN THE WORLD4.4%- 9% POPULATION SUFFERS FROM HCV

ANTI-HCV BY ELISA …..BEST INITIAL TEST EXCEPTIONS

SUSPECTED ACUTE HEP C I IMMUNOCOMPROMISED PT.

HCV RNA BY PCR IF ELISA POSITIVE

IF ANTI-HCV POSITIVE AND PCR NEGATIVE THEN REPEAT PCR AFTER THREE MONTHS TO CONFIRM CONVALESCENCE

ATTAINING SVR

DEFINITION:

SUSTAINED VIROLOGICAL RESPONSE

IS UNDETECTABLE HCV RNA AT 12 WKS

(SVR 12) OR 24 WKS (SVR24)AT THE END OF THERAPY , AS ASSESSED BY SENSITIVE MOLECULAR METHOD LIKE PCR (THE

LOWER LIMIT BEING <15 IU/ML.)

SEARCH FOR OTHER CAUSES OF LIVER DISEASE

ASSESSMENT OF LIVER DISEASE SEVERITY

HCV RNA LEVEL AND GENOTYPE DETERMINATION

DETERMINATION OF HOST GENETICS

UNCONTROLLED PSYCHOSIS/ DEPRESSION/ EPILEPSY

PREGNANCY

RETINAL DISEASE

AUTOIMMUNE THYROID DISEASE

FOR PEGYLATED INTERFERON -ALPHA

ABSOLUTE NEUTROPHIL COUNT <1500/mmPLATELET COUNT < 90,000/mm

ALL TREATMENT- NAÏVE AND –EXPERIENCED PTs WITH COMPENSATED CLD DUE TO HCV

TREATMENT SHOULD BE PRIORTIZED IN PTs WITH SEVERE FIBROSIS (METAVIR SCORE F3/F4)

TREATMENT IS JUSTIFIED IN PTs WITH MODERATE FIBROSIS (METAVIR SCORE F2)

PTs WITH DECOMPENSAATED CLD WHO ARE ON TRANSPLANT LIST SHOULD BE TREATED WITH INTERFERON FREE AND IDEALLY RIBAVIRIN FREE THERAPY

TWO DRUG THERAPY TILL 2009

> INTERFERON ALPHA 2a 180 ug/wkINTERFERON ALPHA 2b 1.5 ug/kg/wk

> RIBAVIRIN 1000 mg/DAY IF WT <75 kg1200mg/DAY IF WT >75 kg

TELAPREVIROR

BOCEPREVIR

SOFOSBUVIR

SIMEPREVIR

DACLATASVIR

1- MONITORING OF EFFICACY

2- STOPPING/FUTILITY RULES

3- VIROLOGICAL RESPONSE GUDED TRIPLE THERAPY

4- SIDE EFFECTS MONITORING

PCR DONE AT 1- BASELINE2- 4 WKS3- 12 WKS4- END OF THERAPY5- 12 & 24 WKS AFTER THE END OF

THERAPY

FOR THERAPY TO BE EFFECTIVE HCV RNA SHOULD BE <15IU/mm

FUTILITY RULES APPLY FOR ONLY TRIPLE COMBINATION THERAPY WITH

IFN- ALPHA, RIBAVIRIN AND SIMEPREVIR

DISCONTINUE IF HCV RNA AT WKS 4/12/24 IS >25 IU/mm

TRIPLE THERAPY WITH IFN-ALPHARIBAVIRINDECLATASVIR

IF HCV RNA >25IU/mm AT 4 WKS AND DETECTABLE AT 10 WKS GIVE TRIPLE THERAPY FOR 24 WKS

IF HCV RNA <25 IU/mm AT 4WKS AND UNDETECTABLE AT 10 WKS DISCONTINUE DECLATASVIR AFTER 12 WKS AND GIVE OTHER 2 MEDS FOR 24 WKS

>PTs RECEIVING IFN AND RIBAVIRIN

1- CLINICAL S/Es AT EACH VISIT

2- HEMATOLOGICAL S/Es AT 2 $ 4 WKS AND THEN AT 4 -8 WK INTERVAL

3- TFTs AT 12 WK INTERVAL

> RFTs SHOULD BE MONITORED REGULARLY IN PTs RECEIVING SOFOSBUVIR

> PTs RECEIVING SIMEPREVIR SHOULD BE MONITORED FOR RASHES AND BILIRUBIN ELEVATION

REPEAT HCV RNA AT 48 WKS IF NEGATIVE IT MEANS THAT PT IS HCV FREE

IN CIRRHOTICS WHO ACHIEVE SVR THE RISK OF HCC IS DECREASED BUT WE NEED SURVEILLANCE AT 6 MONTHS INTERVAL

DIAGNOSIS OF ACUTE AND CHRONIC HCV??

GOALS AND END POINTS OF THERAPY???

PRE-THERAPEUTIC ASSESSMENT???

CONTRAINDICATIONS TO THERAPY???

WHO SHOULD BE TREATED???

MONITORING???

Feelings are much like waves, we cannot stop them from coming but wee can always choose which one to surf.

THANKYOU!!!