RECOMMENDATIONS

Considerations in HCV Treatment

  • Before initiating antiviral therapy, clinicians should assess CrCl, HIV and HBV status, and the degree of fibrosis, among other factors. (A1)
  • Clinicians new to HCV treatment should consult a specialist in treatment of liver disease or viral hepatitis when treating patients who:
    • Have severe renal impairment (CrCl <30 mL/min) and/or are undergoing hemodialysis. (A3)
    • Require retreatment after treatment failure of any DAA regimen. (B3)
  • Clinicians should prescribe RBV with caution for patients with a CrCl <50 mL/min. (A1)
    • If prescribed, a reduced dose of 200 mg per day is required.
    • Non-RBV-containing regimens can be prescribed without dose adjustments for patients with CrCl ≥30 mL/min.

Contraindications

  • Clinicians should not prescribe RBV for treatment of the following patients:
    • Female or male patients planning conception within 6 months of the last dose of RBV. (A2)
    • Male patients who have pregnant partners. (A2)

Abbreviations: CrCl, creatinine clearance; DAA, direct-acting antiviral; HBV, hepatitis B virus; HCV, hepatitis C virus; RBV, ribavirin.

From: Treatment of Chronic Hepatitis C Virus Infection in Adults

Cover of Treatment of Chronic Hepatitis C Virus Infection in Adults
Treatment of Chronic Hepatitis C Virus Infection in Adults [Internet].
Bernstein DE, Aron JS, Kerr CA, et al.
Baltimore (MD): Johns Hopkins University; 2023 Apr.
Copyright © Johns Hopkins University Clinical Guidelines Program 2000-2023. The Clinical Guidelines Program, a collaborative effort of the NYSDOH AI and the Johns Hopkins University School of Medicine, Division of Infectious Diseases, encourages the use, reproduction, and distribution of original documents and related graphics from this program website accompanied by a full citation of source that includes: Author(s). Committee. Title. Date of publication. Full URL. Date accessed. Links to pages on this Clinical Guidelines Program website are also encouraged and may be created without seeking permission. Requests to adapt material, i.e., to change or alter in any way material from this website for inclusion in another publication, should be sent to aiguidelines@jhmi.edu. Please include detailed information about the intended use and desired adaptations.

This book is licensed under the terms of the Attribution-NonCommercial-NoDerivs 3.0 Unported (CC BY-NC-ND 3.0).

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.