Hep C 5-Question Quiz: What Would WHO Do?

September 13, 2018

HCV testing in HIV-infected men who have sex with men should be conducted every 2 years. True or False?

In this month’s quiz, we cover hepatitis C testing recommendations for HIV-infected men, choosing a direct-acting antiviral (DAA) regimen for a kidney transplant patient, patient-friendly descriptions of DAA mechanisms of action, and more. Ready to test your knowledge? Let’s get started.

Question 1.

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Answer: C. Once yearly

According to HCV guidance from the American Association of Liver Disease and Infectious Disease Society of America (AASLD/IDSA) practitioners need to be on “high alert” for acute and usually asymptomatic HCV infection among HIV-infected adolescent and adult MSM. Those individuals should undergo HCV testing once yearly, though more frequent testing may be called for if they engage in sexual practices or drug use that puts them at high risk for infection. The guidelines suggest testing for HCV when starting HIV pre-exposure prophylaxis (PrEP) and at least annually thereafter. These individuals should also be instructed on how to prevent HCV infection and transmission, and should be advised about the risks of transmission associated with certain sexual behaviors and drug use.

Question 2.

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Answer: B. Glecaprevir/pibrentasvir for 12 weeks

A daily fixed-dose combination of glecaprevir/pibrentasvir for 12 weeks is currently recommended as a regimen for both treatment-naive and treatment-experienced kidney transplant patients with HCV genotype 2-6, with or without compensated cirrhosis. An alternative regimen for these patients would be 12 weeks of daily daclatasvir plus sofosbuvir, along with a low initial dose of ribavirin that can be increased as tolerated.

The glecaprevir/pibrentasvir regimen is also recommended for kidney transplant patients with the more common genotype 1; for those patients, ledipasvir/sofosbuvir is also a recommended option.

Question 3.

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Answer: D. Telaprevir

WHO removed recommendations for the protease inhibitors boceprevir and telaprevir in its most recent guidelines for the screening, care, and treatment of individuals with chronic hepatitis C infection. These first-generation DAAs, which were coadministered with interferon and ribavirin, were only effective in the treatment of patients with HCV genotype 1. Also, they had side effects that were common and sometimes severe, especially in individuals who had advanced disease. Newer DAAs are safer, have higher rates of sustained virologic response (SVR), and can be used without interferon and ribavirin.

Question 4.

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Answer: A. They directly target HCV to stop it from making copies of itself

Nucleoside and nucleotide NS5B polymerase inhibitors directly target HCV to stop it from making copies of itself in the liver, according to The Hepatitis C Treatment Information Project. These agents attach themselves to the genetic information, called RNA, to block the virus from multiplying, says this resource from the non-profitPacific Hepatitis C Network. The resource also includes plain-language descriptions of the mechanism of action for non-nucleoside NS5B polymerase inhibitors, NS5A inhibitors, and NS3/4A protease inhibitors.

Question 5.

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Answer: NS3/4A protease inhibitors

Glecaprevir and voxilaprevir are both third-generation NS3/4A protease inhibitors. They are pan-genotypic, meaning they have high antiviral activity, and they result in cure rates over 95% when combined with an NS5A inhibitor. The availability of direct-acting antiviral combinations that include pan-genotypic, third-generation NS3/4A inhibitors represents an opportunity to treat patients with HCV infection without the need for prior genotype testing, according to a recent report in the journal Expert Opinion in Pharmacotherapy.