Chair, Anthony Martinez, MD, AAHIVS, FAASLD, prepared useful Practice Aids pertaining to HCV infection for this CME/MOC/NCPD/CPE activity titled “Sharing the Cure: Best Practices for Primary Care Providers to Improve HCV Prevention, Care, and Treatment.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/NCPD/CPE information, and to apply for credit, please visit us at https://bit.ly/3KQ6D3z. CME/MOC/NCPD/CPE credit will be available until April 20, 2023.
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.
Discussion of the current medications of chronic hepatitis treatment in the Egyptian market as well as our protocol of management in the Viral Hepatitis Treatment Centers in Egypt. Discussion of the latest recommendations of AASLD/IDSA and EASL are presented
Chair, Anthony Martinez, MD, AAHIVS, FAASLD, prepared useful Practice Aids pertaining to HCV infection for this CME/MOC/NCPD/CPE activity titled “Sharing the Cure: Best Practices for Primary Care Providers to Improve HCV Prevention, Care, and Treatment.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/NCPD/CPE information, and to apply for credit, please visit us at https://bit.ly/3KQ6D3z. CME/MOC/NCPD/CPE credit will be available until April 20, 2023.
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.
Discussion of the current medications of chronic hepatitis treatment in the Egyptian market as well as our protocol of management in the Viral Hepatitis Treatment Centers in Egypt. Discussion of the latest recommendations of AASLD/IDSA and EASL are presented
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1. TRAINING OF CORE TRAINERS
MONITORING &
FOLLOW-UP
Dr. Zalwani Zainuddin
Gastroenterologist/Hepatologist
CPG Management of Chronic
Hepatitis C in Adults
2. To learn on:
• monitoring of patients treated with DAAs
• follow-up schedule once patient completed treatment
• referral criteria for hepatitis C
Learning Objectives
2
3. • New DAA regimens are generally well tolerated.
• Frequencies of high grade or severe adverse events leading to
discontinuation are very low.
• The American Association for the Study of Liver Diseases (AASLD)
and the European Association for the Study of the Liver (EASL)
recommend a monitoring schedule that includes baseline, week 4 &
week 12 after the end of treatment.
Monitoring During DAAs
3
5. • Renal function should be checked monthly in patients with reduced
eGFR receiving sofosbuvir (SOF).
• Treatment must be stopped in case of severe adverse events or in
case of a hepatitis flare (ALT levels >10 times normal, if not already
present at the time of starting treatment).
• In patients who need ribavirin (RBV), the dose of RBV should be
adjusted downward by 200 mg in decrements if the haemoglobin
(Hb) level drops <10 g/dL. RBV administration should be stopped if
the Hb levels drops <8.5 g/dL
Monitoring During DAAs -3
5
6. • HIV & HBV co-infection with/without cirrhosis or renal impairment,
presence of potential DDIs & ill-health may also necessitate more
frequent monitoring.
Monitoring During DAAs -4
6
6
8. • A treatment interruption was defined as treatment interruption for >7
days or treatment discontinuation.
• If the interruption of treatment was for ≤7 days, treatment was continued
for the remaining duration as prescribed & SVR12 was assessed 12
weeks after the completion of treatment.
• If interruption of treatment was >7 days & the patient had taken
treatment for <4 weeks, then the treatment was started afresh.
• If interruption of treatment was >7 days & the patient had taken
treatment for ≥4 weeks or more, then HCV RNA was measured after 12
weeks of cessation of drug to assess for SVR12.
Monitoring During DAAs -6
8
8
Missed Dosing
9. ACHIEVED SVR12
NOT CIRRHOTIC
• Patients who achieve
SVR12 can be discharged
• Patient with persistent
deranged LFT should be
investigated for other
causes of liver diseases
• Need to be counsel
regarding possibility of
reinfection amongst high
risk groups
ACHIEVED SVR12
CIRRHOTIC
• Continue follow up for HCC
surveillance: 6-monthly US
liver & blood for AFP
• Endoscopy for OV
surveillance
NO SVR12
• Should monitor for
progression of liver disease
& considered for
retreatment once alternative
treatment is available.
Post-treatment Follow-up
9
9
10. When to Refer
• cirrhosis
• treatment failure
• hepatitis B co-infection
• CKD stage 4 & 5
• extrahepatic manifestation
• haemoglobinopathies
• solid organ transplantation
Patient with compensated cirrhosis,
treatment-naïve should be able to be treated at Klinik Kesihatan or any
physician base clinic.
When to Refer
10
10
11. • New DAA regimen are well tolerated & safe.
• Follow-up & monitoring is recommended at week 4 of treatment & week 12 post
treatment.
• More frequent follow-up should be tailored to patient's characteristic such as
cirrhosis, regimen containing ribavirin, renal impairment, HIV/HBV co-infection,
multiple comorbidities.
• Non-cirrhotic patients without other liver diseases who has achieved SVR12 can
be discharged from follow-up.
• Cirrhotic patients who achieved SVR12 will need surveillance for HCC.
Take Home Messages
11
11