hepatitis c updated treatment protocol (egytian guidelines)
TRANSCRIPT
Hepatitis C Updated Treatment Protocol
By:-
Sayed Hanzal Ass. Lecturer of Hepatogastroenterology
fayoum univ.
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
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
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
Endpoint of therapy
• undetectable HCV RNA 12 weeks (SVR12) and 24 weeks (SVR24) after the end of treatment
Drugs available and there mech. ????
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
Egyptian guidelines for HCV ttt ?????
• 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 %)
Prvious ttt with DAAs
naive
easy difficult
experienced
Sof +dac Sof +sim
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
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
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
post organ transplantation
SOF/DAC/RBV for 24Ws
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.
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 )