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Patient handout

Chronic Hepatitis C

PRODUCTION

1. Your condition

This handout is for chronic hepatitis c. Your care team identified this based on: anti-hcv antibody positive (screening or reflex) (aasld/idsa hcv 2023).

Other reasons your team may use this plan: hcv rna detectable - confirmed chronic infection (aasld/idsa hcv 2023); universal one-time screening adults >=18 + pregnancy + risk factors (pwid, hiv, dialysis, msm) (aasld/idsa hcv 2023); unexplained alt/ast elevation - workup includes hcv (aasld/idsa hcv 2023).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

MedicationStarting doseHowWhenWhat it does
glecaprevir_pibrentasvir300/120 mg (3 tablets) PO once daily with food x 8 weeksPOonce dailyAASLD/IDSA HCV 2023 (PMID 37229695) - Mavyret 8 wk pan-genotypic for treatment-naive without decompensation; SVR12 >95%
sofosbuvir_velpatasvir400/100 mg (1 tablet) PO once daily x 12 weeksPOonce dailyAASLD/IDSA HCV 2023 - Epclusa 12 wk pan-genotypic; preferred when amiodarone-co-prescribed avoided OR shorter regimen contraindicated

Plan: Chronic HCV - pan-genotypic DAA by treatment experience + cirrhosis status (AASLD/IDSA HCV 2023)

3. When to call your provider

Contact your care team if any of the following happen:

  • Decompensation during DAA - hold protease inhibitor and switch to sofosbuvir/velpatasvir +/- RBV; hepatology urgent (AASLD/IDSA HCV 2023)
  • HBV reactivation during DAA - start entecavir or TAF immediately; hepatology urgent (AASLD/IDSA HCV 2023)
  • Severe ribavirin anemia (Hb <8.5) - reduce dose or hold; transfuse if symptomatic (AASLD/IDSA HCV 2023)
  • Treatment failure (detectable RNA at SVR12) - retreatment with sofosbuvir/velpatasvir/voxilaprevir + resistance testing (AASLD/IDSA HCV 2023)
  • New HCC on surveillance - tumor board + multidisciplinary care (AASLD/IDSA HCV 2023)

5. Follow-up

Post-SVR: cured HCV - continue HCC surveillance q6mo (US +/- AFP) ONLY if fibrosis F3-F4 (cirrhosis persists despite cure); EGD per Baveno VII if cirrhotic; reinfection monitoring (annual HCV RNA in PWID/ongoing risk); alcohol cessation; vaccinations (HAV/HBV/influenza/PCV20/COVID); harm reduction; mental health and addiction support (AASLD/IDSA HCV 2023)

6. Sources

Guideline: AASLD/IDSA Hepatitis C Guidance 2023 Update (Bhattacharya, Clinical Infectious Diseases 2023) - current floor; living document at hcvguidelines.org

  1. pubmed.ncbi.nlm.nih.gov/37229695