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Hepatitis C: Have we Found the Right Formula?

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Dr Paul J Thuluvath, Baltimore 05 December 2018

Limitations of pangenotypic drugs:

Sofosbuvir + velpatasvir for 12 weeks (contraindicated when GFR < 30 ml)
Glecaprevir + pibrentasvir for 8-12 weeks (safe in renal failure and dialysis, but unsafe in child B and child C cirrhosis)
Sofosbuvir + velpatasvir + voxilaprevir for 12 weeks (For DAA failures, contraindicated with GFR < 30 ml)

National guidelines in India in:

Treatment naïve HCV without cirrhosis: Sofosbuvir (400 mg) + daclatasvir (60 mg) for 12 weeks
Treatment naïve HCV with cirrhosis: Sofosbuvir (400 mg) + velpatasvir (100 mg) for 12 weeks
Decompensated cirrhosis with HCV: Sofosbuvir (400 mg) + velpatasvir (100 mg) + ribavirin for 12 weeks (24 weeks if intolerant of ribavirin)

HCV treatment in renal failure (GFR < 30 ml/min) patients:

Use combination of drugs with no renal clearance
Grazoprevir/elbasvir for genotype 1, 4-6
Glecaprevir/pibrentasvir for all genotypes

Challenges in HCV treatment in India and elsewhere:

Screening and linkage to care
Costs and affordability
Special populations such as people with renal failure, people who fail DAA treatment that included a NS5A inhibitor
Advanced liver disease

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