This document summarizes guidelines from the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) for the treatment of hepatitis C virus (HCV) infection. It provides recommendations for testing, treatment goals, treatment regimens, duration based on genotype and cirrhosis status, and monitoring for a variety of patient populations. Key recommendations include treating all patients with chronic HCV infection with direct-acting antiviral regimens of 8 to 12 weeks depending on genotype and cirrhosis status, and using longer durations of 24 weeks for decompensated cirrhosis patients who are ineligible for ribavirin.
Hospital Medicine Pearls, VA ACP Meeting 2014Jon Sweet
This document summarizes recent evidence from studies on various topics in hospital medicine:
1. For patients with atherosclerotic renal artery stenosis, renal artery stenting provides no benefit over optimal medical therapy alone and should not be performed.
2. For COPD exacerbations, a 5-day course of prednisone is as effective as the typical 14-day course with fewer steroid-related side effects.
3. Restrictive transfusion strategies (transfusing at Hb <7 g/dL) reduce mortality, rebleeding and complications compared to liberal strategies in patients with upper GI bleeding and acute MI.
4. For overt hepatic encephalopathy, rifaximin added to lactulose
The document provides guidelines for the management and treatment of malaria cases in India. It outlines that the first priority is clinical management to reduce morbidity and mortality. It then describes appropriate treatment for malaria depending on the level of facility, from large hospitals with intensive care capabilities to small hospitals with more limited resources. It provides detailed treatment guidelines for both adults and children based on severity of symptoms and malaria risk of the area. It also discusses disease control strategies like case detection, treatment, mass drug administration, and chemoprophylaxis.
This document summarizes guidelines for anticoagulation therapy, including direct oral anticoagulants (DOACs) such as dabigatran, rivaroxaban, apixaban, and edoxaban. It discusses their indications, dosing, efficacy, safety profiles compared to warfarin, drug interactions, and perioperative management. The key points are that DOACs are generally noninferior or superior to warfarin for stroke prevention with equal or lower risks of bleeding, though drug interactions and the lack of reversal agents for some need to be considered. Perioperative bridging therapy should only be used selectively for high-risk patients, and interruption of anticoagulation should be
Webinar Series on COVID-19: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research, NIH
Speaker: Dr Yasmin Gani, ID Physician, Hospital Sungai Buloh, MOH Malaysia.
More info about the speaker and this webinar available here: https://clinupcovid.mailerpage.com/resources/g7e5g8-medical-management-of-covid-19-an
02.03 adult art monitoring, changing gsnDavid Ngogoyo
This document discusses monitoring and changing antiretroviral therapy (ART) and potential drug interactions. It covers:
1. Monitoring ART through clinical evaluations and laboratory tests to assess efficacy, toxicity, and treatment success.
2. Reasons for changing or stopping ART including drug toxicity/intolerance, drug interactions, and treatment failure. Common toxicities discussed include rash, hepatotoxicity, hematological toxicity, peripheral neuropathy, and pancreatitis.
3. Potential drug interactions with ART like rifampicin reducing nevirapine levels or efavirenz levels being affected by certain other drugs. Managing interactions and avoiding additive toxicities is important.
1) A study of 174 patients with severe alcoholic hepatitis found that those who received steroids plus N-acetylcysteine had improved one-month survival and a decreased risk of hepatic renal syndrome, though no overall improvement in six-month survival.
2) A randomized trial of 26 patients with severe alcoholic hepatitis who did not respond to medical therapy found that early liver transplantation improved six-month survival to 77% compared to 23% for matched non-transplanted controls.
3) Two studies found that rifaximin significantly improved cognitive function and quality of life in patients with minimal hepatic encephalopathy, with one study also finding an improvement in driving simulator performance with rifaximin treatment.
The document discusses five new medications for behavioral health conditions: levomilnacipran, vilazodone, vortioxetine, brexpiprazole, and cariprazine. It provides details on indications, mechanisms of action, dosing, efficacy and safety data, adverse effects, place in therapy, and access and pricing considerations for treating patients at the Community-University Health Center with these agents. Key factors discussed in evaluating the medications include efficacy, tolerability, side effect profile, access through insurance plans and patient assistance programs, and sustainability for patients.
This document discusses the management of Hepatitis C in 2019 and beyond. It provides guidance on assessing liver disease, treatment aims and options, and available drugs in Pakistan. Key points include:
- Assessing liver disease involves tests of the blood, liver function, imaging and virological testing.
- Treatment aims to prevent liver complications and improve quality of life. The endpoint is an undetectable viral load 12 weeks post treatment (SVR12).
- Available drugs for genotype 3 infection include Sofosbuvir/Velpatasvir for 12 weeks in non-cirrhotic patients or Glecaprevir/Pibrentasvir for 8-12 weeks depending on fibrosis stage.
-
Hospital Medicine Pearls, VA ACP Meeting 2014Jon Sweet
This document summarizes recent evidence from studies on various topics in hospital medicine:
1. For patients with atherosclerotic renal artery stenosis, renal artery stenting provides no benefit over optimal medical therapy alone and should not be performed.
2. For COPD exacerbations, a 5-day course of prednisone is as effective as the typical 14-day course with fewer steroid-related side effects.
3. Restrictive transfusion strategies (transfusing at Hb <7 g/dL) reduce mortality, rebleeding and complications compared to liberal strategies in patients with upper GI bleeding and acute MI.
4. For overt hepatic encephalopathy, rifaximin added to lactulose
The document provides guidelines for the management and treatment of malaria cases in India. It outlines that the first priority is clinical management to reduce morbidity and mortality. It then describes appropriate treatment for malaria depending on the level of facility, from large hospitals with intensive care capabilities to small hospitals with more limited resources. It provides detailed treatment guidelines for both adults and children based on severity of symptoms and malaria risk of the area. It also discusses disease control strategies like case detection, treatment, mass drug administration, and chemoprophylaxis.
This document summarizes guidelines for anticoagulation therapy, including direct oral anticoagulants (DOACs) such as dabigatran, rivaroxaban, apixaban, and edoxaban. It discusses their indications, dosing, efficacy, safety profiles compared to warfarin, drug interactions, and perioperative management. The key points are that DOACs are generally noninferior or superior to warfarin for stroke prevention with equal or lower risks of bleeding, though drug interactions and the lack of reversal agents for some need to be considered. Perioperative bridging therapy should only be used selectively for high-risk patients, and interruption of anticoagulation should be
Webinar Series on COVID-19: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research, NIH
Speaker: Dr Yasmin Gani, ID Physician, Hospital Sungai Buloh, MOH Malaysia.
More info about the speaker and this webinar available here: https://clinupcovid.mailerpage.com/resources/g7e5g8-medical-management-of-covid-19-an
02.03 adult art monitoring, changing gsnDavid Ngogoyo
This document discusses monitoring and changing antiretroviral therapy (ART) and potential drug interactions. It covers:
1. Monitoring ART through clinical evaluations and laboratory tests to assess efficacy, toxicity, and treatment success.
2. Reasons for changing or stopping ART including drug toxicity/intolerance, drug interactions, and treatment failure. Common toxicities discussed include rash, hepatotoxicity, hematological toxicity, peripheral neuropathy, and pancreatitis.
3. Potential drug interactions with ART like rifampicin reducing nevirapine levels or efavirenz levels being affected by certain other drugs. Managing interactions and avoiding additive toxicities is important.
1) A study of 174 patients with severe alcoholic hepatitis found that those who received steroids plus N-acetylcysteine had improved one-month survival and a decreased risk of hepatic renal syndrome, though no overall improvement in six-month survival.
2) A randomized trial of 26 patients with severe alcoholic hepatitis who did not respond to medical therapy found that early liver transplantation improved six-month survival to 77% compared to 23% for matched non-transplanted controls.
3) Two studies found that rifaximin significantly improved cognitive function and quality of life in patients with minimal hepatic encephalopathy, with one study also finding an improvement in driving simulator performance with rifaximin treatment.
The document discusses five new medications for behavioral health conditions: levomilnacipran, vilazodone, vortioxetine, brexpiprazole, and cariprazine. It provides details on indications, mechanisms of action, dosing, efficacy and safety data, adverse effects, place in therapy, and access and pricing considerations for treating patients at the Community-University Health Center with these agents. Key factors discussed in evaluating the medications include efficacy, tolerability, side effect profile, access through insurance plans and patient assistance programs, and sustainability for patients.
This document discusses the management of Hepatitis C in 2019 and beyond. It provides guidance on assessing liver disease, treatment aims and options, and available drugs in Pakistan. Key points include:
- Assessing liver disease involves tests of the blood, liver function, imaging and virological testing.
- Treatment aims to prevent liver complications and improve quality of life. The endpoint is an undetectable viral load 12 weeks post treatment (SVR12).
- Available drugs for genotype 3 infection include Sofosbuvir/Velpatasvir for 12 weeks in non-cirrhotic patients or Glecaprevir/Pibrentasvir for 8-12 weeks depending on fibrosis stage.
-
Cardiovascular Medications in Older Adults PASaskatchewan
This document discusses managing cardiovascular medications in older adults. Key points include:
- Medication requirements often change with age due to physiological changes
- Older adults are at higher risk for both cardiovascular events and adverse drug reactions
- Managing medications for older adults presents challenges like multimorbidity, polypharmacy, altered pharmacokinetics, and adherence issues
- The document reviews these considerations for an individual case study patient and his medications for atrial fibrillation, hypertension, and dyslipidemia. Resources for guiding decisions in older adults are also provided.
This document summarizes hepatitis C treatments and outreach efforts. It discusses current and upcoming antiviral treatments including simeprevir, sofosbuvir, and direct-acting antivirals. It also describes side effects of pegylated interferon and ribavirin treatments. The document estimates hepatitis C prevalence in Lambeth and the potential impact of untreated infection based on natural disease progression models. It overviews the antiviral therapy outreach service collaboration between Kings College Hospital and South London and Maudsley to engage patients in drug and alcohol centers through peer advocacy.
Hospital Medicine Update, VA ACP Meeting 2015Jon Sweet
This document summarizes a presentation on papers that have changed the presenter's medical practice. It discusses several clinical cases and the evidence from recent studies on how to best manage them. For a patient with upper GI bleeding admitted after endoscopic treatment, intermittent PPI therapy is shown to be non-inferior to continuous infusion PPI based on multiple randomized trials. For heart failure patients under 75, BNP-guided treatment reduces mortality and hospitalizations compared to clinical guidance alone. Lower steroid doses are associated with better outcomes for COPD patients admitted to the ICU. MRCP or EUS are recommended for evaluating the CBD in patients at intermediate risk of retained stones.
This document discusses vaccination recommendations for adolescents, preconception, and during pregnancy. It provides guidance on routine vaccinations such as Tdap, HPV, influenza, and meningococcal vaccines for adolescents. It also discusses catch-up vaccinations for hepatitis B, MMR, varicella, hepatitis A, and typhoid. The effectiveness and schedules for 2-dose HPV vaccination in adolescents is reviewed. Preconception vaccination guidance emphasizes determining immune status for rubella, varicella and hepatitis B and vaccinating susceptible women.
This document provides a morning report on a case of malaria. It summarizes the patient's history, including previous malaria infections, physical examination findings, laboratory test results showing Plasmodium vivax, and diagnosis of malaria tertiana. The patient's treatment plan includes IV fluids, antipyretics, anti-malarial medications, and patient education.
This patient is a 23-year-old female who presented with generalized swelling and abdominal pain for 8 months. Her symptoms started 2 years ago with abdominal pain and obstruction, for which she was diagnosed with FMF and treated with colchicine. Over time she developed edema, ascites, hepatomegaly and thrombocytopenia. She was diagnosed with lupus based on positive ANA and anti-DNA antibodies, but subsequent tests for these were negative. Workup revealed hepatic vein and IVC thrombosis consistent with Budd-Chiari syndrome. Testing found protein C deficiency and lupus anticoagulant consistent with antiphospholipid antibody syndrome. She was started on anticoagulation, diure
Protective effects of n acetylcysteine on aluminum sukumar new 2222 (1)Sukumar Msuku
This study evaluated the protective effects of N-acetyl cysteine (NAC) on oxidative stress caused by aluminum phosphide poisoning. The study randomly assigned 37 patients with aluminum phosphide poisoning to either a treatment group that received NAC or a control group. Levels of malondialdehyde and total antioxidant capacity were measured at admission and 24 hours. The NAC group showed a significant decrease in malondialdehyde levels and no change in antioxidant levels, while the control group showed increased malondialdehyde and antioxidants. The NAC group also had lower rates of mechanical ventilation, shorter hospitalization, and lower mortality. The study concludes that NAC administration may help reduce oxidative stress and improve outcomes in aluminum phosphide poisoning.
This document discusses tuberculosis (TB) globally and in Pakistan. It notes that TB infects over 1 billion people worldwide and causes millions of deaths each year. Pakistan has a high burden of TB, ranking 8th globally. The document then covers diagnosis and treatment of TB, including different regimens for new cases, re-treatment cases, and special populations like pregnant women, infants, and those with renal impairment or HIV/AIDS. It discusses managing TB in patients with conditions like silicosis or hepatitis induced by anti-TB treatment. The goal is to provide guidance on treating TB in complex situations.
- The POINT trial investigated whether clopidogrel plus aspirin reduces new ischemic vascular events compared to placebo plus aspirin in patients with minor stroke or high-risk TIA treated within 12 hours.
- Over 4,800 patients from 269 sites in 10 countries were randomly assigned to clopidogrel+aspirin or placebo+aspirin. Patients receiving clopidogrel had a 25% lower risk of stroke or other ischemic events but a higher risk of major bleeding.
- The trial was stopped early due to a safety signal of increased major hemorrhage in the clopidogrel group. However, clopidogrel was found to provide benefit for ischemic outcomes within the first 3 weeks
The document provides a morning report on a fever of unknown origin case. It summarizes:
1) A 58-year-old male presented with prolonged fever for 1 month despite previous antibiotic treatment for presumed typhoid fever. He had weight loss and decreased appetite.
2) Physical exam was normal but labs showed leukocytosis, increased CRP, and hyponatremia. Imaging found hydronephrosis and nephrolithiasis.
3) Differential diagnoses for the fever of unknown origin were discussed, including further diagnostic tests needed to establish a diagnosis. Control of diabetes and urology follow-up were also mentioned.
This document provides protocols for COVID-19 management at AIIMS. It discusses criteria for suspecting COVID-19 cases, guidelines for asymptomatic and symptomatic healthcare workers exposed to COVID-19, and protocols for managing mild, moderate and severe COVID-19 cases. It also outlines protocols for prone ventilation, transferring intubated patients, discharge criteria, and home isolation eligibility. The document provides detailed instructions for patients and their family members on self-isolation and environmental sanitation.
Anti tuberculosis drug - induced hepatitis – A Case Studyvelspharmd
This case report describes a 32-year-old male patient who developed hepatotoxicity after being administered first-line anti-tuberculosis drugs to treat pulmonary tuberculosis. The patient also had a history of heavy alcohol use. Laboratory tests showed elevated liver enzymes and abdominal ultrasound revealed grade IV fatty liver infiltration. The patient was diagnosed with anti-TB drug-induced hepatitis exacerbated by alcohol-induced liver damage. His condition improved after discontinuing the anti-TB medications and alcohol, receiving supportive care, and standard treatment. The case report discusses the risk of hepatotoxicity from anti-TB drugs and importance of considering patient risk factors like alcohol use.
The COV-BOOST study evaluated the immune response to different heterologous COVID-19 vaccine boosters. It found that all boosters, except the Valneva vaccine after a Pfizer primary series, increased antibody levels and neutralization compared to baseline. mRNA vaccines like Pfizer and Moderna boosted antibodies more than AstraZeneca or Novavax, which boosted more than adenovirus vector vaccines as a booster. Reactogenicity was generally higher for Moderna and CureVac boosters and adenovirus vector boosters after a Pfizer primary series. While the study provides data on immune responses, the clinical effectiveness of these booster combinations still needs validation through outcomes like infections and disease severity.
The document discusses management of HIV in children in India. It describes three cases: 1) a 2.5 year old girl with failure to gain weight and recurrent infections who should start ART based on her clinical staging and CD4 count, 2) a 6 year old boy with pulmonary tuberculosis who should start anti-TB treatment first before ART to reduce the risk of immune reconstitution inflammatory syndrome (IRIS), and 3) a 6 year old boy who developed anemia likely due to zidovudine toxicity and requires substitution of his antiretroviral regimen. The document provides guidelines on when to start ART in children, appropriate first-line regimens, managing drug toxicities and co-infections like tuberculosis,
This document discusses the classification, diagnosis, and management of hypertensive disorders that can occur during pregnancy. It describes four main types: gestational hypertension, preeclampsia, chronic hypertension, and preeclampsia superimposed on chronic hypertension. It provides details on evaluating and monitoring patients with these conditions, indications for delivery, and guidelines for different antihypertensive medications. The management of severe preeclampsia, HELLP syndrome, and eclampsia is covered, including magnesium sulfate administration and expectations for maternal and fetal stabilization and delivery.
Mgh COVID-19 Treatment Guidance March 17, 2020Ken Yale
This document was developed by members of the ID division at MGH in conjunction with pharmacy, radiology, and other medicine divisions to provide guidance to frontline clinicians caring for patients with COVID-19. This document covers potential off-label and/or experimental use of medications and immunosuppression management for transplant patients as well as a suggested laboratory work up. It does NOT cover recommendations for infection control, PPE, management of hypoxemia or other complications in patients with COVID-19. This is a living document that will be updated in real time as more data emerge.
This document provides information on COVID-19 infection, including its symptoms, diagnostic tests, and treatment approaches. It describes the stages of infection from uncomplicated illness to septic shock. Treatment recommendations include vitamin and mineral supplements, antiviral and anti-inflammatory drugs, oxygen support, anticoagulation, intensive care as needed. For critical cases, salvage therapies like plasma exchange and ECMO are mentioned. Close monitoring of markers and managing post-ICU care is also outlined.
Vymada Tablet (ARNI: Angiotensin Receptor Neprilysin Inhibitor) is an anti-hypertensive drug used in combination with Sacubitril & Valsartan to reduce the risk of cardiovascular events in patients with chronic heart failure (NYHA Class II-IV) and reduced ejection fraction.
The document summarizes several drug approvals and updates from the FDA in August 2017. Mavyret was approved for treating HCV genotypes 1-6 without cirrhosis or with compensated cirrhosis. Carospir received approval as an oral suspension for heart failure, hypertension, and hepatic edema. Duzallo was approved as a combination of lesinurad and allopurinol for treating gout in patients not at target uric acid levels on allopurinol alone. Vabomere was approved for complicated UTIs caused by designated bacteria. Other notable approvals included Idhifa for AML, Besponsa for ALL, and Benznidazole for Chagas disease in pediatric patients.
A power point presentation on Hepatitis C virus on epidemiology, presentation, diagnosis and current treatment strategies we are practicing in BSMMU at a international standerd.
Lecture 7 - Monitoring & Followup Dr Zalwani.pptxongjeetat
This document provides guidance on monitoring and follow-up for patients treated with direct-acting antiviral (DAA) regimens for hepatitis C. It recommends monitoring during treatment at baseline, week 4, and week 12 after treatment completion. More frequent monitoring is needed for those with cirrhosis, reduced kidney function, or other comorbidities. After treatment, non-cirrhotic patients who achieve a sustained virologic response can be discharged, while cirrhotic patients require continued surveillance for hepatocellular carcinoma. Referral criteria include cirrhosis, treatment failure, hepatitis B coinfection, and other complications.
Direct-acting antivirals such as elbasvir-grazoprevir, glecaprevir-pibrentasvir, ledipasvir-sofosbuvir, and sofosbuvir-velpatasvir are highly effective at treating hepatitis C, with over 90% of patients achieving sustained virologic response. They work by directly inhibiting HCV proteins like NS3, NS5A, and NS5B to prevent viral replication. Common side effects are mild and include fatigue, headache, and nausea. Ribavirin is sometimes used in combination with direct-acting antivirals to improve response rates, especially in difficult-to-treat patient groups, but can cause hemolytic anemia
Cardiovascular Medications in Older Adults PASaskatchewan
This document discusses managing cardiovascular medications in older adults. Key points include:
- Medication requirements often change with age due to physiological changes
- Older adults are at higher risk for both cardiovascular events and adverse drug reactions
- Managing medications for older adults presents challenges like multimorbidity, polypharmacy, altered pharmacokinetics, and adherence issues
- The document reviews these considerations for an individual case study patient and his medications for atrial fibrillation, hypertension, and dyslipidemia. Resources for guiding decisions in older adults are also provided.
This document summarizes hepatitis C treatments and outreach efforts. It discusses current and upcoming antiviral treatments including simeprevir, sofosbuvir, and direct-acting antivirals. It also describes side effects of pegylated interferon and ribavirin treatments. The document estimates hepatitis C prevalence in Lambeth and the potential impact of untreated infection based on natural disease progression models. It overviews the antiviral therapy outreach service collaboration between Kings College Hospital and South London and Maudsley to engage patients in drug and alcohol centers through peer advocacy.
Hospital Medicine Update, VA ACP Meeting 2015Jon Sweet
This document summarizes a presentation on papers that have changed the presenter's medical practice. It discusses several clinical cases and the evidence from recent studies on how to best manage them. For a patient with upper GI bleeding admitted after endoscopic treatment, intermittent PPI therapy is shown to be non-inferior to continuous infusion PPI based on multiple randomized trials. For heart failure patients under 75, BNP-guided treatment reduces mortality and hospitalizations compared to clinical guidance alone. Lower steroid doses are associated with better outcomes for COPD patients admitted to the ICU. MRCP or EUS are recommended for evaluating the CBD in patients at intermediate risk of retained stones.
This document discusses vaccination recommendations for adolescents, preconception, and during pregnancy. It provides guidance on routine vaccinations such as Tdap, HPV, influenza, and meningococcal vaccines for adolescents. It also discusses catch-up vaccinations for hepatitis B, MMR, varicella, hepatitis A, and typhoid. The effectiveness and schedules for 2-dose HPV vaccination in adolescents is reviewed. Preconception vaccination guidance emphasizes determining immune status for rubella, varicella and hepatitis B and vaccinating susceptible women.
This document provides a morning report on a case of malaria. It summarizes the patient's history, including previous malaria infections, physical examination findings, laboratory test results showing Plasmodium vivax, and diagnosis of malaria tertiana. The patient's treatment plan includes IV fluids, antipyretics, anti-malarial medications, and patient education.
This patient is a 23-year-old female who presented with generalized swelling and abdominal pain for 8 months. Her symptoms started 2 years ago with abdominal pain and obstruction, for which she was diagnosed with FMF and treated with colchicine. Over time she developed edema, ascites, hepatomegaly and thrombocytopenia. She was diagnosed with lupus based on positive ANA and anti-DNA antibodies, but subsequent tests for these were negative. Workup revealed hepatic vein and IVC thrombosis consistent with Budd-Chiari syndrome. Testing found protein C deficiency and lupus anticoagulant consistent with antiphospholipid antibody syndrome. She was started on anticoagulation, diure
Protective effects of n acetylcysteine on aluminum sukumar new 2222 (1)Sukumar Msuku
This study evaluated the protective effects of N-acetyl cysteine (NAC) on oxidative stress caused by aluminum phosphide poisoning. The study randomly assigned 37 patients with aluminum phosphide poisoning to either a treatment group that received NAC or a control group. Levels of malondialdehyde and total antioxidant capacity were measured at admission and 24 hours. The NAC group showed a significant decrease in malondialdehyde levels and no change in antioxidant levels, while the control group showed increased malondialdehyde and antioxidants. The NAC group also had lower rates of mechanical ventilation, shorter hospitalization, and lower mortality. The study concludes that NAC administration may help reduce oxidative stress and improve outcomes in aluminum phosphide poisoning.
This document discusses tuberculosis (TB) globally and in Pakistan. It notes that TB infects over 1 billion people worldwide and causes millions of deaths each year. Pakistan has a high burden of TB, ranking 8th globally. The document then covers diagnosis and treatment of TB, including different regimens for new cases, re-treatment cases, and special populations like pregnant women, infants, and those with renal impairment or HIV/AIDS. It discusses managing TB in patients with conditions like silicosis or hepatitis induced by anti-TB treatment. The goal is to provide guidance on treating TB in complex situations.
- The POINT trial investigated whether clopidogrel plus aspirin reduces new ischemic vascular events compared to placebo plus aspirin in patients with minor stroke or high-risk TIA treated within 12 hours.
- Over 4,800 patients from 269 sites in 10 countries were randomly assigned to clopidogrel+aspirin or placebo+aspirin. Patients receiving clopidogrel had a 25% lower risk of stroke or other ischemic events but a higher risk of major bleeding.
- The trial was stopped early due to a safety signal of increased major hemorrhage in the clopidogrel group. However, clopidogrel was found to provide benefit for ischemic outcomes within the first 3 weeks
The document provides a morning report on a fever of unknown origin case. It summarizes:
1) A 58-year-old male presented with prolonged fever for 1 month despite previous antibiotic treatment for presumed typhoid fever. He had weight loss and decreased appetite.
2) Physical exam was normal but labs showed leukocytosis, increased CRP, and hyponatremia. Imaging found hydronephrosis and nephrolithiasis.
3) Differential diagnoses for the fever of unknown origin were discussed, including further diagnostic tests needed to establish a diagnosis. Control of diabetes and urology follow-up were also mentioned.
This document provides protocols for COVID-19 management at AIIMS. It discusses criteria for suspecting COVID-19 cases, guidelines for asymptomatic and symptomatic healthcare workers exposed to COVID-19, and protocols for managing mild, moderate and severe COVID-19 cases. It also outlines protocols for prone ventilation, transferring intubated patients, discharge criteria, and home isolation eligibility. The document provides detailed instructions for patients and their family members on self-isolation and environmental sanitation.
Anti tuberculosis drug - induced hepatitis – A Case Studyvelspharmd
This case report describes a 32-year-old male patient who developed hepatotoxicity after being administered first-line anti-tuberculosis drugs to treat pulmonary tuberculosis. The patient also had a history of heavy alcohol use. Laboratory tests showed elevated liver enzymes and abdominal ultrasound revealed grade IV fatty liver infiltration. The patient was diagnosed with anti-TB drug-induced hepatitis exacerbated by alcohol-induced liver damage. His condition improved after discontinuing the anti-TB medications and alcohol, receiving supportive care, and standard treatment. The case report discusses the risk of hepatotoxicity from anti-TB drugs and importance of considering patient risk factors like alcohol use.
The COV-BOOST study evaluated the immune response to different heterologous COVID-19 vaccine boosters. It found that all boosters, except the Valneva vaccine after a Pfizer primary series, increased antibody levels and neutralization compared to baseline. mRNA vaccines like Pfizer and Moderna boosted antibodies more than AstraZeneca or Novavax, which boosted more than adenovirus vector vaccines as a booster. Reactogenicity was generally higher for Moderna and CureVac boosters and adenovirus vector boosters after a Pfizer primary series. While the study provides data on immune responses, the clinical effectiveness of these booster combinations still needs validation through outcomes like infections and disease severity.
The document discusses management of HIV in children in India. It describes three cases: 1) a 2.5 year old girl with failure to gain weight and recurrent infections who should start ART based on her clinical staging and CD4 count, 2) a 6 year old boy with pulmonary tuberculosis who should start anti-TB treatment first before ART to reduce the risk of immune reconstitution inflammatory syndrome (IRIS), and 3) a 6 year old boy who developed anemia likely due to zidovudine toxicity and requires substitution of his antiretroviral regimen. The document provides guidelines on when to start ART in children, appropriate first-line regimens, managing drug toxicities and co-infections like tuberculosis,
This document discusses the classification, diagnosis, and management of hypertensive disorders that can occur during pregnancy. It describes four main types: gestational hypertension, preeclampsia, chronic hypertension, and preeclampsia superimposed on chronic hypertension. It provides details on evaluating and monitoring patients with these conditions, indications for delivery, and guidelines for different antihypertensive medications. The management of severe preeclampsia, HELLP syndrome, and eclampsia is covered, including magnesium sulfate administration and expectations for maternal and fetal stabilization and delivery.
Mgh COVID-19 Treatment Guidance March 17, 2020Ken Yale
This document was developed by members of the ID division at MGH in conjunction with pharmacy, radiology, and other medicine divisions to provide guidance to frontline clinicians caring for patients with COVID-19. This document covers potential off-label and/or experimental use of medications and immunosuppression management for transplant patients as well as a suggested laboratory work up. It does NOT cover recommendations for infection control, PPE, management of hypoxemia or other complications in patients with COVID-19. This is a living document that will be updated in real time as more data emerge.
This document provides information on COVID-19 infection, including its symptoms, diagnostic tests, and treatment approaches. It describes the stages of infection from uncomplicated illness to septic shock. Treatment recommendations include vitamin and mineral supplements, antiviral and anti-inflammatory drugs, oxygen support, anticoagulation, intensive care as needed. For critical cases, salvage therapies like plasma exchange and ECMO are mentioned. Close monitoring of markers and managing post-ICU care is also outlined.
Vymada Tablet (ARNI: Angiotensin Receptor Neprilysin Inhibitor) is an anti-hypertensive drug used in combination with Sacubitril & Valsartan to reduce the risk of cardiovascular events in patients with chronic heart failure (NYHA Class II-IV) and reduced ejection fraction.
The document summarizes several drug approvals and updates from the FDA in August 2017. Mavyret was approved for treating HCV genotypes 1-6 without cirrhosis or with compensated cirrhosis. Carospir received approval as an oral suspension for heart failure, hypertension, and hepatic edema. Duzallo was approved as a combination of lesinurad and allopurinol for treating gout in patients not at target uric acid levels on allopurinol alone. Vabomere was approved for complicated UTIs caused by designated bacteria. Other notable approvals included Idhifa for AML, Besponsa for ALL, and Benznidazole for Chagas disease in pediatric patients.
A power point presentation on Hepatitis C virus on epidemiology, presentation, diagnosis and current treatment strategies we are practicing in BSMMU at a international standerd.
Lecture 7 - Monitoring & Followup Dr Zalwani.pptxongjeetat
This document provides guidance on monitoring and follow-up for patients treated with direct-acting antiviral (DAA) regimens for hepatitis C. It recommends monitoring during treatment at baseline, week 4, and week 12 after treatment completion. More frequent monitoring is needed for those with cirrhosis, reduced kidney function, or other comorbidities. After treatment, non-cirrhotic patients who achieve a sustained virologic response can be discharged, while cirrhotic patients require continued surveillance for hepatocellular carcinoma. Referral criteria include cirrhosis, treatment failure, hepatitis B coinfection, and other complications.
Direct-acting antivirals such as elbasvir-grazoprevir, glecaprevir-pibrentasvir, ledipasvir-sofosbuvir, and sofosbuvir-velpatasvir are highly effective at treating hepatitis C, with over 90% of patients achieving sustained virologic response. They work by directly inhibiting HCV proteins like NS3, NS5A, and NS5B to prevent viral replication. Common side effects are mild and include fatigue, headache, and nausea. Ribavirin is sometimes used in combination with direct-acting antivirals to improve response rates, especially in difficult-to-treat patient groups, but can cause hemolytic anemia
This document discusses tuberculosis (TB) management in special situations. It provides WHO guidelines for TB treatment regimens based on category of TB, including doses and duration of treatment. It also summarizes TB treatment considerations for pregnancy, breastfeeding, infants, liver disease, renal disease, HIV co-infection, and other groups. Key recommendations include safe drugs to use in pregnancy, dose adjustments for liver and renal impairment, and extending TB treatment duration for certain high-risk patients.
Hepatitis C affects over 184 million people worldwide and is a major cause of chronic liver disease. It is caused by the hepatitis C virus and transmitted via contact with infected blood. New highly effective direct acting antiviral regimens can cure over 95% of infections and guidelines recommend treatment for all patients except those who will receive a liver transplant within 6 months. Treatment involves combinations of antiviral drugs tailored to hepatitis C genotype and cirrhosis status, with sustained virologic response assessed 12-24 weeks post treatment indicating cure.
This document summarizes a clinical trial that evaluated the safety and efficacy of patiromer for treating hyperkalemia in patients with chronic kidney disease receiving RAAS inhibitors. The trial had two phases - an initial 4-week treatment phase followed by an 8-week randomized withdrawal phase. Results showed that patiromer significantly reduced serum potassium levels and maintained normokalemia compared to placebo. The most common side effects were constipation and diarrhea. The authors concluded that patiromer was effective for treating hyperkalemia and allowing continued use of RAAS inhibitors in patients with chronic kidney disease.
Rivaroxaban is a Factor Xa inhibitor. This presentation covers in brief regarding need for NOACs, kinetics, effects, indications, dosage, toxity, and antidote of rivaroxaban. It also covers in brief all the published trials
Kawasaki disease is an acute vasculitis that predominantly affects coronary arteries in children. It is characterized by fever, rash, conjunctival injection, cervical lymphadenopathy, and changes to the mouth and lips. The cause is unknown but may involve a novel RNA virus. Treatment involves intravenous immunoglobulin and aspirin to reduce inflammation and prevent coronary artery abnormalities. Refractory cases may require additional immunomodulating therapies.
This document provides guidance for acute gastroenterology issues commonly seen in acute medical units. It summarizes guidelines on screening for alcohol use, appropriate blood transfusion levels for GI bleeds, paracetamol overdose treatment, and safely refeeding underweight patients to avoid complications.
This document summarizes a seminar on the management of hepatitis C. It discusses the virology of hepatitis C virus and outlines guidelines for patient evaluation, counseling, and antiviral therapy. The summary focuses on the evolution of hepatitis C treatment from interferon-based regimens to highly effective all-oral direct-acting antiviral combination therapies that achieve over 95% cure rates.
This document provides guidance statements on the diagnosis, evaluation and management of ascites, spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS) for patients with cirrhosis. It recommends moderate sodium restriction and diuretic therapy as first-line treatment for ascites. Large volume paracentesis is recommended for severe ascites. Albumin infusion and antibiotics are recommended for SBP treatment and prophylaxis. Vasoconstrictor drugs in combination with albumin are the treatment of choice for HRS, with terlipressin as the preferred drug.
1) The ATTIRE trial investigated whether daily albumin infusions would reduce infections and organ dysfunction in hospitalized patients with cirrhosis compared to standard care. 2) Over 700 patients with cirrhosis were randomly assigned to either daily albumin infusions or standard care without explicit albumin therapy for up to 14 days. 3) The trial found no benefit of albumin therapy over standard care on the composite primary outcome of infections, organ dysfunction and mortality.
Pharmacists will soon be able to offer comprehensive travel consultations including prescribing travel-related vaccines. This session will serve as an introduction to the topic by taking you through the most common questions faced in community pharmacy.
Factor Xa inhibitors such as rivaroxaban, apixaban, and edoxaban are oral anticoagulants used to treat and prevent blood clots such as deep vein thrombosis and pulmonary embolism. They work by directly inhibiting Factor Xa in the coagulation cascade. Clinical trials showed they are as effective as warfarin for reducing strokes in atrial fibrillation with less risk of bleeding. New reversal agents are being developed for Factor Xa inhibitors like andexanet alfa to counteract their anticoagulant effects in emergency situations.
Factor Xa inhibitors such as rivaroxaban, apixaban, and edoxaban are oral anticoagulants used to treat and prevent blood clots such as deep vein thrombosis and pulmonary embolism. They work by inhibiting factor Xa in the coagulation cascade. Clinical trials showed they are as effective as warfarin for reducing strokes in atrial fibrillation with less risk of bleeding. New reversal agents such as andexanet alfa are in development to counteract the anticoagulant effects in emergency situations.
1) ATT induced hepatitis refers to drug-induced liver injury caused by anti-tuberculosis treatment medications like isoniazid, rifampin, and pyrazinamide.
2) These drugs can cause a spectrum of liver damage from asymptomatic transaminase elevations to acute liver failure via both idiosyncratic and dose-dependent mechanisms including intracellular calcium disruption and apoptosis.
3) Risk factors for tuberculosis drug-induced liver injury include older age, female sex, extra-pulmonary or meningeal tuberculosis, malnutrition, alcohol use, viral hepatitis coinfection, and certain genetic factors. Careful monitoring of liver enzymes is recommended during treatment.
Hepatitis (C) Story …. Past & Present & future
Most Recant Updating Guidelines by ASSLD & FDA
RAVS &How to deal with It ----12/7/2016.....
((Residents Lectures))
Ledipasvir and Sofosbuvir Tablets Taj Pharma SmPCTajPharmaQC
Ledipasvir and Sofosbuvir Tablets 90mg/400mg Taj Pharma: Uses, Side Effects, Interactions, Pictures, Warnings, Ledipasvir and Sofosbuvir Dosage & Rx Info | Ledipasvir and Sofosbuvir Uses, Side Effects Ledipasvir and Sofosbuvir: Indications, Side Effects, Warnings, Ledipasvir and Sofosbuvir -Drug Information –Taj Pharma, Ledipasvir and Sofosbuvir dose Taj pharmaceuticals Ledipasvir and Sofosbuvir interactions, Taj Pharmaceutical Ledipasvir and Sofosbuvir contraindications, Ledipasvir and Sofosbuvir price, Ledipasvir and Sofosbuvir Taj Pharma Ledipasvir and Sofosbuvir SmPC-Taj Pharma Stay connected to all updated on Ledipasvir and Sofosbuvir Taj Pharmaceuticals Mumbai. Patient Information Leaflets, SmPC.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
Muscles of Mastication by Dr. Rabia Inam Gandapore.pptx
hep c guidelines 2018
1. HEP-C GUIDELINES 2018 AASLD- IDSA
RECOMMONDEATION
MODERATED BY :- Dr . M .U .
Ashraf
PRESENTED BY :- Rishabh
Patel
JR – 2
2. BACKGROUND ABOUT HEPATITIS C
• Enveloped RNA virus
• Family Flaviviridae
• Incubation period 2-26 weeks
• Maximum risk( potential) leading to chronic hepatitis
• Most common cause of viral cirrhosis
• Cause acute illness (fatigue ,jaundice)—less than 20%
• Chronic infection– 85%
• Chronic hepatitis—70%
• Cirrhosis –15% which may lead to HCC.
4. RECOMMENDATIONS FOR ONE TIME HEPATITIS C TESTING
• Injection drug user
• Long term haemodialysis
• Healthcare ,emergency medical, public safety workers after needle
sticks sharps or mucosal exposures to HCV infected blood
• Recipients of organ/transfusion
• HIV infection
• Sexually active workers
• Children's born to HCV infected mother.
5.
6.
7. GOAL OF TREATMENT
• The goal of treatment of HCV infected persons to reduce all causes
mortality and liver related health adverse consequences including end
stage liver disease and hepatocellular carcinoma, by the achievement of
virologic cure as evidenced by sustained virologic response(SVR).(SVR--
absence of detectable HCV RNA for at least 12 weeks after completion of
therapy)
RECOMMENDATION FOR WHEN AND IN WHOM TO INITIATE
TREATMENT
• Treatment is recommended for all patients with chronic HCV infection
,except those with short expectancy that cannot be remediated by HCV
therapy ,liver transplantation.
8. RECOMMENDED ASSESSMENT PRIOR TO STARTING ANTIVIRAL
THERAPY
• HCV genotype
• Quantative HCV RNA (HCV viral load)
• Complete blood count
• International normalised ratio
• Liver function test
• Renal function test
• CTP score
• Current or prior history of decompensated liver disease
• Staging of hepatic fibrosis(invasive or non invasive)
• HBV or HIV coinfection
• Presence of resistance associated substitutions(RASs)
9. RECOMMENDED ASSESSMENT DURING ANTIVIRAL THERAPY
• RFT,LFT –4 weekly
• CBC—if ribavirin is included in regimen
• 10 or more fold increase in ALT—discontinuation of therapy
• Less than10 fold with nausea ,vomiting ,jaundice ,significantly increase
bilirubin ,ALP ,INR---discontinuation of therapy
• Less than 10 fold and without symptoms—repeat testing at 2 weeks
10. RECOMMENDED MONITORING FOR PATIENTS IN WHOM TREATMENT
FAILED TO ACHIEVE A SUSTAINED VIROLOGIC RESPONSE
• Disease progression assessment every 6 to 12 months with a LFT , CBC
, INR
• Screening for HCC with USG every 6 months in pt with advanced
fibrosis
• Endoscopic screening for oesophageal varices is recommended if
cirrhosis is present
• Evaluation for retreatment is recommended as effective alternative
treatments become available.
11. RECOMMENDED FOLLOW-UP FOR PATIENTS IN WHO ACHIEVED A
SUSTAINED VIROLOGIC RESPONSE
• For patients who do not have advanced fibrosis ,recommended follow
up is the same as if they were never infected with HCV
• Assessment for HCV recurrence or reinfection is recommended only if
the patients has ongoing risk for HCV infection or otherwise
unexplained hepatic dysfunctions develops. In such cases a quantative
HCV RNA test rather than HCV antibody test is recommended in
recurrence or reinfection
• Screening for HCC with USG every 6 months in pt with advanced
fibrosis
• Endoscopic screening for oesophageal varices is recommended if
cirrhosis is present
12. LANDMARKS IN ANTIVIRAL
THERAPY
• THE INTERFERON ERA (1991-2011)
• FIRST GENERATION PROTEASE INHIBITOR ERA(2011-2013)
• NS5A AND NS5B ERA (DAA ERA)
15. DRUG DOSES DRUG DOSES
SOFOSBUVIR 400mg DACLATASVIR 60mg
LEDIPASVIR 90mg ELBASVIR 50mg
PARITAPREVIR 150mg GRAZOPREVIR 100mg
RITONAVIR 100mg VELPATASVIR 100mg
OMBITASVIR 25mg VOXILAPREVIR 100mg
DASABUVIR 250mg RIBAVARIN >-
75**
1200mg
SIMEPREVIR 150mg <75 1000mg
** Wt BASED RIBAVARIN REGIMEN.
ONE MORE REGIMEN KNOWN AS LOW DOES REGIMEN STARTED WITH
600mg AND ESCALATION OF DOSES GRADUALLY AFTER LIVER ENZYMES
16. FEW POINTS ABOUT DAA
• Oral, interferon free, simple dosing ,low pills burden , brief treatment
duration.
• High potency ,high barrier to resistance , pan genotypic activity , well
tolerated.
• Adverse effects-mild fatigue ,insomnia ,headache ,nausea ,bradycardia .
• Contraindicated with amiodarone , and used cautiously with beta blocker.
• Protease inhibitor associated with aminotransferase elevations and potentia
hepatotoxicity.
17. FEW POINTS ABOUT RIBAVARIN
• Add on therapy
• Most pronounced side effect is haemolysis ;decrease haemoglobin up
to 2-3 gm/dl
• So avoided in patients with anaemia, haemoglobinopathies , patients
with CAD,CVA
• Also renal toxic ,so avoided
• Teratogenic anti proliferative activity so contraindicated in pregnancy
• If there is no other option , can be consider in anaemic patient in
reduced does ,or erythropoietin.
18. 1a 1b 2 3 4 5&6
ELBASVIR*+GRAZOPREVIR 12
WEEKS
12
WEEKS
----- ----- 12**
WEEKS
-----
GLECAPREVIR+PIBRENTASVI
R
8
WEEKS
8
WEEKS
8
WEEKS
8
WEEKS
8
WEEKS
8
WEEKS
SOFOSBUVIR+VELPATASVIR 12
WEEKS
12
WEEKS
12
WEEKS
12
WEEKS
12
WEEKS
12
WEEKS
LEDIPASVIR+SOFOSBUVIR**
*
12
WEEKS
12
WEEKS
----- ----- 12**
WEEKS
12**
WEEKS
GENOTYPE( THERAPY IN DURATION OF
WEEKS)
TREATMENT NAÏVE GENOTYPE PATIENT WITHOUT
CIRRHOSIS
• * FOR GT1a,CHECK RASs TO NS5A,USE A DIFFERENT RECOMMONDED REGIMEN IF HIGH FOLD
VARIANTS DETECTED
• ** NOT A CLASS I RECOMMENDATION
• *** IF NO CIRRHOSIS,NON BLACK,HIV NEGATIVE AND HCV RNA <106 IU/ mL THAN DURATION OF
THERAPY 8 WEEK CAN BE CONSIDERED(I,B)
19. 1a 1b 2 3 4 5&6
ELBASVIR*+GRAZOPREVIR 12
WEEKS
12
WEEKS
----- ----- 12**
WEEKS
-----
GLECAPREVIR+PIBRENTASVI
R
12
WEEKS
12
WEEKS
12
WEEKS
12
WEEKS
12
WEEKS
12
WEEKS
SOFOSBUVIR+VELPATASVIR 12
WEEKS
12
WEEKS
12
WEEKS
12
WEEKS
12
WEEKS
12
WEEKS
LEDIPASVIR+SOFOSBUVIR 12
WEEKS
12
WEEKS
----- ----- 12**
WEEKS
12**
WEEKS
GENOTYPE( THERAPY IN DURATION OF
WEEKS)
TREATMENT NAÏVE GENOTYPE PATIENT WITH COMPENSATED
CIRRHOSIS
• * FOR GT1a,CHECK RASs TO NS5A,USE A DIFFERENT RECOMMONDED REGIMEN IF HIGH FOLD
VARIANTS DETECTED
• ** NOT A CLASS I RECOMMENDATION
20. 1a 1b 2 3 4 5&6
ELBASVIR*+GRAZOPREVIR 12
WEEKS
12
WEEKS
----- ----- 12**
WEEKS
-----
GLECAPREVIR+PIBRENTASVI
R
8
WEEKS
8
WEEKS
8
WEEKS
----- 8**
WEEKS
8**
WEEKS
SOFOSBUVIR+VELPATASVIR 12
WEEKS
12
WEEKS
12
WEEKS
12
WEEKS
12
WEEKS
12**
WEEKS
LEDIPASVIR+SOFOSBUVIR 12
WEEKS
12
WEEKS
----- ----- 12**
WEEKS
12**
WEEKS
GENOTYPE( THERAPY IN DURATION OF
WEEKS)
PEGINTERFERON/RIBAVARIN EXPERIENCED GENOTYPE PATIENT
WITHOUT CIRRHOSIS
• * FOR GT1a,CHECK RASs TO NS5A,USE A DIFFERENT RECOMMONDED REGIMEN IF HIGH FOLD
VARIANTS DETECTED
• ** NOT A CLASS I RECOMMENDATION
21. 1a 1b 2 3@ 4 5&6
ELBASVIR*+GRAZOPREVIR 12
WEEKS
12
WEEKS
----- ----- 12**
WEEKS
-----
GLECAPREVIR+PIBRENTASVI
R
12
WEEKS
12
WEEKS
12
WEEKS
----- 12**
WEEKS
12
WEEKS
SOFOSBUVIR+VELPATASVIR 12
WEEKS
12
WEEKS
12
WEEKS
----- 12
WEEKS
12**
WEEKS
LEDIPASVIR+SOFOSBUVIR ----- ----- ----- ----- ----- 12**
WEEKS
GENOTYPE( THERAPY IN DURATION OF
WEEKS)
PEGINTERFERON/RIBAVARIN EXPERIENCED GENOTYPE PATIENT
WITH COMPENSATED CIRRHOSIS
• @ ELBASVIR+GRAZOPREVIR+SOFOSBUVIR ----12 WEEK CLASS I
RECOMMENDATION
SOFOSBUVIR+VELPATASVIR+VOXILAPREVIR----12 WEEK CLASS II
RECOMMENDATION
22. WITHOUT CIRRHOSIS COMPENSATED
CIRRHOSIS
GLECAPREVIR+PIBRENTAS
VIR
12 WEEKS* 12 WEEKS*
SOFOSBUVIR+VELPATASVI
R
12 WEEKS 12 WEEKS
LEDIPASVIR+SOFOSBUVIR 12 WEEKS 12 WEEKS**
NS 3 PROTEASE INHIBITOR(TELAPREVIR,BOCEPREVIR,SIMEPREVIR)
/PEGINTERFERON/RIBAVARIN EXPERIENCED GENOTYPE 1
PATIENT WITHOUT CIRRHOSIS OR COMPENSATED CIRRHOSIS
( THERAPY IN DURATION OF WEEKS)
• * NOT A CLASS I RECOMMENDATION
• ** ALTERNATIVE REGIMEN--- WEIGHT BASED RIBAVARIN TO BE ADDED
23. GENOTYPE 1a GENOTYPE 1b
GLECAPREVIR+PIBRENTAS
VIR
12 WEEKS* 12 WEEKS*
SOFOSBUVIR+VELPATASVI
R
----- 12 WEEKS
SOFOSBUVIR+VELPATASVI
R
+VOXILAPREVIR
12 WEEKS -----
NON NS5A INHIBITOR SOFOSBUVIR CONTAINING REGIMEN
EXPERIENCED GENOTYPE 1 PATIENT WITHOUT CIRRHOSIS OR
COMPENSATED CIRRHOSIS
( THERAPY IN DURATION OF WEEKS)
• * NOT A CLASS I RECOMMENDATION
25. 1a 1b 2 3 4 5&6
SOFOSBUVIR+VELPATASVIR
+VOXILAPREVIR
12
WEEKS
12
WEEKS
12
WEEKS
12
WEEKS
12
WEEKS
12*
WEEKS
GENOTYPE( THERAPY IN DURATION OF
WEEKS)
DAA EXPERIENCED(INCLUSING NS5A INHIBITORS) GENOTYPE
PATIENT WITHOUT CIRRHOSIS AND COMPENSATED CIRRHOSIS
• * NOT A CLASS I RECOMMENDATION
26. 1a 1b 2 3 4 5&6
DACLATASVIR+SOFOSUVIR
WITH LOW DOES RIBAVARIN
12
WEEKS
12
WEEKS
12*
WEEKS
12*
WEEKS
12
WEEKS
-----
SOFOSBUVIR+VELPATASVIR
WITH Wt BASED RIBAVARIN
12
WEEKS
12
WEEKS
12
WEEKS
12
WEEKS
12
WEEKS
12
WEEKS
LEDIPASVIR+SOFOSBUVIR
WITH LOW DOES RIBAVARIN
12
WEEKS
12
WEEKS
----- ----- 12
WEEKS
12
WEEKS
GENOTYPE( THERAPY IN DURATION OF
WEEKS)
PATIENT WITH DECOMPENSATED CIRRHOSIS AND RIBAVARIN
ELIGIBLE
• * NOT A CLASS I RECOMMENDATION
• Pt WITH CTP CLASS B,C ------LIVER TRANSPLANT CLASS I C
RECOMMENDATION.
27. 1a 1b 2 3 4 5&6
DACLATASVIR+SOFOSUVIR 24*
WEEKS
24*
WEEKS
24*
WEEKS
24*
WEEKS
24*
WEEKS
-----
SOFOSBUVIR+VELPATASVIR 24
WEEKS
24
WEEKS
24
WEEKS
24
WEEKS
24
WEEKS
24
WEEKS
LEDIPASVIR+SOFOSBUVIR 24
WEEKS
24
WEEKS
----- ----- 24
WEEKS
24
WEEKS
GENOTYPE( THERAPY IN DURATION OF
WEEKS)
PATIENT WITH DECOMPENSATED CIRRHOSIS AND RIBAVARIN
INELIGIBLE
• * NOT A CLASS I RECOMMENDATION
28. 1a 1b 2 3 4 5&6
SOFOSBUVIR+VELPATASVIR
WITH WT BASED RIBAVARIN
24
WEEKS
24
WEEKS
24
WEEKS
24
WEEKS
24
WEEKS
24
WEEKS
LEDIPASVIR+SOFOSBUVIR
WIYH LOW DOES RIBAVARIN
24
WEEKS
24
WEEKS
----- ----- 24
WEEKS
24
WEEKS
GENOTYPE( THERAPY IN DURATION OF
WEEKS)
PATIENT WITH DECOMPENSATED CIRRHOSIS WITH PRIOR
SOFOSBUVIR OR NS5A BASED TREATMENT FAILURE
29. TREATMENT RECOMMENDATIOS FOR PATIENTS WITH HIV/HCV
COINFECTION
• HIV/HCV coinfected person should be treated and retreated the same as
person without HIV infection and managing interactions with antiviral
medications.
• Daily DACLATASVIR +SOFOSBUVIR WITH OR WITHOUT RIBAVIRIN is a
recommended regimen when antiviral regimen changes cannot be made
to accommodate alternative HCV direct acting antiviral.
• LEDIPASVIR+SOFOSBUVIR for 8 weeks is not recommended, regardless
of baseline HCV RNA level.
30. GENOTYPE DURATION (WEEKS)
CKD STAGE 1,2,3 FOLLOW STANDARD DIRECT ACTING
ANTIVIRALS AGENTS(TREATMENT
GUIDENCE)
CKD STAGE 4,5
ELBASVIR +GRAZOPREVIR 1a,1b,4 12 WEEKS
GLECAPREVIR+PIBRENTASVIR 1,2,3,4,5,6 12 WEEKS
RECOMMONDED REGIMENS FOR PATIENTS WITH CHRONIC
KIDNEY DISEASE
31. DAA REGIMEN IN UNIQUE POPULATION
ACUTE HEPATITS C :-
• Monitoring HCV RNA for at least 12 to 16 weeks before starting treatment is
recommended.
• If initiating treatment during acute infection period to minimize onward
transmission or loss to follow up , the same regimen are recommended as for
chronic HCV .
CHILDREN AND ADLOSCENTS:-
• If direct antiviral regimens are available for child age group, treatment is
recommended for all hepatitis c virus infected children aged >3 years.
• The presence of extrahepatic manifestation such as cryoglobulinemia rashes
32. ALONG WITH HEPATITIS B :-
• For patients whose HBV DNA level meets AASLD criteria for treatment ,
antiviral therapy for HBV should be initiated.
• For patients whose baseline HBV DNA level does not meet criteria for
treatment , one of two approaches may be taken:-
Initiate prophylactic antiviral therapy for those with low or undetectable
HBV DNA levels. Prophylaxis should be continued until 12 weeks after
completion of DAA therapy.
Monitor HBV DNA levels during and immediately after DAA therapy for
HCV . Antiviral treatment for HBV should be given in the event of rise in
HBV DNA > 10 fold above baseline or to >1000 IU/ml in those with
previously undectable or unquantifiable HBV DNA level.
33. LEDIPASVIR+SOFOSBUVIR FOR Pt WITH GT1—TREATMENT NAÏVE WITHOUT
CIRRHOSIS OR COMPENSATED CIRRHOSIS OR TREATMENT EXPERIENCED WITHOUT
CIRRHOSIS
12
WEEKS
LEDIPASVIR+SOFOSBUVIR FOR Pt WITH GT1— TREATMENT EXPERIENCED WITH
COMPENSATED CIRRHOSIS
24
WEEKS
SOFOSBUVIR + Wt BASESD RIBAVARIN FOR Pt WITH GT2—TREATMENT NAÏVE OR
TREATMENT EXPERIENCED WITHOUT CIRRHOSIS OR COMPENSATED CIRRHOSIS
12
WEEKS
SOFOSBUVIR + Wt BASESD RIBAVARIN FOR Pt WITH GT3—TREATMENT NAÏVE OR
TREATMENT EXPERIENCED WITHOUT CIRRHOSIS OR COMPENSATED CIRRHOSIS
24
WEEKS
SOFOSBUVIR + LEDIPASVIRFOR Pt WITH GT4,5,6—TREATMENT NAÏVE OR
TREATMENT EXPERIENCED WITHOUT CIRRHOSIS OR COMPENSATED CIRRHOSIS
12
WEEKS
RECOMMONDED REGIMENS FOR ADLOSCENTS AGED >_12 YEARS OR
WEIGHING >_ 35 KG
34. PREGNANCY:-
• DAA therapy is not recommended for pregnant women due to lack of safety
and efficacy data.
• For women of reproductive age with known HCV ,antiviral therapy is
recommended.
• HCV RNA and routine LFT is recommended during prenatal care, and
revaluated after delivery to assess for spontaneous clearance.
• All children born to HCV infected women should be tested by antibody
based test at or after 18 months of age. If positive , should be accessed for
HCV RNA assay after 3 year to confirm chronic hepatitis.