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Management of chronic HCV infection, By Dr. Maham Khan - Coggle Diagram
Management of chronic HCV infection
Management of HCV infection for treatment Naive or relapser patients
Genotype 1
Recommendation 1:
elbasvir 50mg + grazoprevir 100mg daily for 12 weeks
Recommendation 2:
valpatasvir 100mg + sofosbuvir 400mg daily for 12 weeks
Recommendation 3:
daclatasvir 60 mg + sofosbuvir 400mg daily for 12 weeks
Recommendation 4:
ledipasvir 90 mg + sofosbuvir 400mg daily for 12 weeks
Recommendation 5:
paritaprevir 150mg + ritonavir 100mg+ ombitasvir 25mg + twice daily dasabuvir 250mg + weight based RBV for 12 weeks
Recommendation 6:
sofosbuvir 400mg + simeprevir 150mg for 12 weeks
Genotype 2
Recommendation 1:
velptasvir 100mg + sofosbuvir 400mg daily for 12 weeks
Recommendation 2:
Daclatasvir 60mg + sofosbuvir 400mg daily for 12 weeks
Recommendation 3:
sofosbuvir 400mg + weight based RBV for 12 weeks
Genotype 3
Recommendation 1:
daclatasvir 60mg + sofosbuvir 400mg daily for 12 weeks
Recommendation 2:
valpatasvir 100mg + sofosbuvir 400mg daily for 12 weeks
Recommendation 3:
sofosbuvir 400mg + weight based RBV + weekly PEG-IFN for 12 weeks ( for patients eligible for IFN)
Recommendation 4:
sofosbuvir 400mg + weight based RBV for 24 weeks ( for patients ineligible for IFN)
Genotype 4
Recommendation 1:
paritaprevir 150mg + ritonavir 100mg + ombitasvir 25mg + weight based RBV for 12 weeks
Recommendation 2:
valpatasvir 100mg + sofosbuvir 400mg daily for 12 weeks
Recommendation 3:
Elbasvir 50mg + grazoprevir 100mg daily for 12 weeks
Recommendation 4:
ladipasvir 90mg + sofosbuvir 400mg for 12 weeks
Genotype 5 and 6
Recommendation 1:
valpatasvir 100mg + sofosbuvir 400mg daily for 12 weeks
Recommendation 2:
lefipasvir 90mg + sofosbuvir 400mg for 12 weeks
Management of HCV infection for treatment failure patients who are SOF/RBV with or without PEG/IFN treated in the past.
Genotype 3
Recommendation 1:
daclatasvir 60mg + sofosbuvir 400mg + weight based RBV daily for 24 weeks irrespective of cirrhosis
velpatasvir 100mg + sofosbuvir 400mg + weight based RBV daily for 12 weeks irrespective of cirrhosis
Genotype 4
Recommendation 1:
ledipasvir 90mg + sofosbuvir 400mg with weight based RBV for 12 weeks for non-cirrhotics and 24 weeks for cirrhotics
Recommendation 2:
daclatasvir 60mg + sofosbuvir 400mg with weight based RBV for 12 weeks for non-cirrhotics and 24 weeks for cirrhotics
Recommendation 3:
paritaprevir 150mg + ritonavir 100mg + ombitasvir 25mg + weight based RBV for 12 weeks for non-cirrhotics and 24 weeks for cirrhotics
Genotype 2
Recommendation 1:
velpatasvir 100mg + sofosbuvir 400mg with RBV daily for 12 weeks irrespective of cirrhosis
Recommendation 2:
daclatasvir 60mg + sofosbuvir 400mg with or without RBV daily for 24 weeks irrespective of cirrhosis
Genotype 5and 6
Recommendation 1:
ledipasvir 90mg + sofosbuvir 400mg with weight based RBV for 12 weeks for non-cirrhotics and 24 weeks for cirrhotics
Recommendation 2:
daclatasvir 60mg + sofosbuvir 400mg with weight based RBV for 12 weeks for non-cirrhotics and 24 weeks for cirrhotics
Genotype 1
Recommendation 1:
ledipasvir 90mg + sofosbuvir 400mg with weight based RBV for 12 weeks for non-cirrhotic and 24 weeks for cirrhotic
Recommendation 2:
daclatasvir 60mg + sofosbuvir 400mg + weight based RBV for 12 weeks for non cirrhotics and 24 weeks for cirrhotics
Management of. HCV infection for treatment failure patients who are IFN/RBV experienced in the past
Genotype 1
Recommendation 1:
elbasvir 50mg + grazoprevir 100mg daily for 12 weeks
Recommendation 2:
velpatasvir 100mg + sofosbuvir 400mg daily for 12 weeks
Recommendation 3:
daclatasvir 60mg + sofosbuvir 400mg daily for 12 week
Recommendation 4:
ledipasvir 90mg + sofosbuvir 400mg for 12 weeks
Recommendation 5:
paritaprevir 150mg + ritonavir 100mg + ombitasvir 25mg + twice daily dasabuvir 250mg + weight beard RBV for 12 weeks
Recommendation 6:
sofosbuvir 400mg + simeprevir 150mg for 12 weeks
Genotype 2
Recommendation 1:
velpatasvir 100mg + sofosbuvir 400mg daily for 12 weeks
Recommendation 2:
daclatasvir 60mg + sofosbuvir 400mg daily for 12 weeks
Recommendation 3:
sofosbuvir 400mg + weight based RBV for 16 weeks or 24 weeks whereas SOF 400mg + weight based RBV + weekly PEG-IFN for 12 weeks of only IFN eligible.
Genotype 3
Recommendation 1:
daclatasvir 60mg + sofosbuvir 400mg daily for 12 weeks
Recommendation 2:
velpatasvir 100mg + sofosbuvir 400mg daily for 12 weeks
Recommendation 3:
sofosbuvir 400mg + weight based RBV + weekly PEG-IFN for 12 weeks
Genotype 4
Recommendation 1:
paritaprevir 150mg + ritonavir 100mg + ombitasvir 25mg + weight based RBV for 12 weeks
Recommendation 2:
sofosbuvir 400mg + velpatasvir 100mg daily for 12 weeks
Recommendation 3:
elbasvir 50mg + grazoprevir 100mg + weight based RBV daily for 16 weeks
Recommendation 4:
ledipasvir 90mg + sofosbuvir 400mg for 12 weeks
Genotype 5 and 6
Recommendation 1:
ledipasvir 90mg + sofosbuvir 409mg for 12 weeks
Recommendation 2:
sofosbuvir 400mg + velpatasvir 100mg daily for 12 weeks
Management of HCV infection in patients with Decompensated cirrhosis
Genotype 2 or 3
Recommendation 1:
Daclatasvir 60mg + sofosbuvir 400mg + RBV (initial dose of 600mg increased as tolerated) for 12 weeks
Recommendation 2:
Sofosbuvir 400mg + velpatasvir 100mg + weight based RBV for 12 weeks
Genotype 1 or 4
Recommendation 1:
daclatasvir 60mg + sofosbuvir 400mg + RBV (initial dose 600mg increased as tolerated) for 12 weeks. For RBV ineligible patients the regimen can be extended for 24 weeks without RBV
Recommendation 2:
velpatasvir 100mg sofosbuvir 400mg + RBV (initial dose of 600mg increased as tolerated) for 12 weeks. For RBV ineligible can be extended for 24 weeks without RBV
Recommendation 3:
ledipasvir 90mg + sofosbuvir 400mg + RBV (initial dose of 600mg increased as tolerated) for 12 weeks. For RBV ineligible patients the regimen can be extended for 24 weeks without RBV.
Counseling of infected person to avoid transmission of HCV
Avoid sharing tooth brushes, shaving razors, blades, scissors and towels.
Cover the bleeding areas to keep their blood away from others
Should not donate blood or body organs
Counseling should be done regarding illicit drugs needle sharing.
Proper disposal of vomit and other body secretions of HCV patients with disinfectant.
Barrier techniques are not recommended as risk for sexual transmission is very low.
By Dr. Maham Khan