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What is the main drawback to Lamivudine?
Resistance increases with every year of therapy
What drugs would you use for Lamivudine resistant strains of HBV?
Adefovir or Entecavir
What are the main issues with Oral HBV drugs?
Resistance and exacerbation of disease upon D/C
What dictates the treatment in HCV?
Which is the most difficult genotype to treat in HCV?
G1 = found mainly in the US
What are the treatment indications for HCV?
- Positive HCV antibodies for > 6 months
- Positive HCV RNA
- Elevated serum aminotransferase levels
- Histologic evidence of inflammation (liver biopsy)
How long are usual HCV treatments?
12-48 weeks (depending on genotype)
What is the dosing for Peginterferon-α2a (Pegasys)
What is the dosing for – Peginterferon-α2b (PegIntron)?
- 1.5 mg/kg
- Once weekly SUBQ
Peginterferons always come in combination with what other drug for the treatment of HCV?
What is the dosing for Ribavirin
- < 75 kg = 1000mg
- > 75 kg = 1200mg
- Weight-based daily PO
What are the direct acting agents for treatment of HCV?
- 1st Gen:
- 2nd Gen:
What is the dose for Boceprevir in HCV treatment?
- 800mg PO TID
- Requires 4 week lead in period with Interferon + Ribavirin
What is the dose for Telaprevir in HCV treatment?
- 1125mg PO BID
- Must be given with Interferon + Ribavirin
What is the dose for Sofosbuvir in HCV treatment?
400mg PO Daily
What is the dose for Simeprevir in HCV treatment?
150mg PO Daily
What is the MOA of direct acting agents used for HCV?
Block viral replication at specific region of HCV genome
What are the advantages of second generation Direct acting agents over 1st gen in treatment of HCV?
- 2nd gen are QD (vs. BID/TID)
- 2nd gen do not have to be given with Ribavirin and Interferon
What are the CIs for Interferon Alpha?
- Current or HX of psychosis
- Severe depression
- Symptomatic heart disease
- Decompensated cirrhosis
- Uncontrolled seizures
- Organ transplantation
What are the CIs for Ribavirin?
- Pregnancy (Category X)
- Risk of pregnancy
- End-stage renal failure
- Severe heart disease
If a patient is interferon eligible, has Genotype 1 and is treatment Naïve, what would you treat them with?
Sofosbuvir, Ribavirin, and IFN weekly x 12 weeks
If a patient is interferon INeligible, has Genotype 1 and is treatment Naïve, what would you treat them with?
- Sofosbuvir + Simeprevir + Ribavirin x 12 weeks
- Sofosbuvir + Ribavirin x 24 weeks
Do NOT treat decompensated cirrhosis caused by HCV genotype 1 with what two drugs?
Interferon or Simeprevir
How should you treat HCV genotype 2, treatment naïve patients?
Sofosbuvir + Ribavirin for 12 weeks
What should you not use to treat HCV genotype 2, treatment naïve patients?
- Monotherapy with any drug
- Interferon + Ribavirin for 24 weeks
- Telaprevir, Boceprevir, or Simeprevir based regimens