In May 2018 the AASLD/IDSA added new testing and management recommendations to its hepatitis C virus (HCV) guidance for special populations. Are you up to date? Find out with the June quiz which highlights changes to guidelines for:
- HCV testing in pregnant women and HIV-negative men
- Management of acute HCV infection
- Treatment choices after an NS5A inhibitor fails
- Follow-up care for chronically infected former prison inmates
Click through the slides above for questions, answers, and links to these specific updates.
Question 1: Which pregnant women should be tested for HCV infection?
Answer: D. All pregnant women. An HCV diagnosis can guide obstetric practices, such as avoidance of internal fetal monitoring during labor. In addition, diagnosing the infection at the point of prenatal care would facilitate linkage to post-delivery HCV care, as well as setting the stage for appropriate screening and care for the exposed infant.
Specific population guidance here.
Question 2: Which route of exposure is associated with the highest risk of acute HCV infection?
Answer: C. Exposure to injection drug use equipment. Needle-stick injuries in healthcare workers are associated with lower HCV transmission rates. Heterosexual exposure represents a very low risk route, while transmission rates are much higher in HIV-infected men having unprotected sex with men.
Specific population guidance here.
Question 3: Which regimens are recommended for HCV genotype 1 patients with a history of NS5A inhibitor treatment failure?
Answer: A. Sofosbuvir/velpatasvir/voxilaprevir. An overall SVR12 rate of 97% was reported for HCV genotype 1 patients in the POLARIS-1 study.1 The guidelines list glecaprevir/pibrentasvir as an alternative regimen for NS5A-experienced HCV genotype 1 patients based on results of the MAGELLAN-1 trial.2
Specific population guidance here.
Question 4: What proportion of prison inmates referred to HCV medical care in the community would be expected to attend a follow-up appointment after their release, based on a linkage to care study in North and South Carolina jails?3
Answer: C. ~50%. Prisoners with chronic HCV infection may contribute to HCV spread after they re-enter the general population and may have minimal contact with the health care system. Current guidelines recommend that infected inmates should be provided linkage to community healthcare for surveillance of complications related to HCV.
Specific population guidance here.
Question 5: In general, how often should HCV testing occur in HIV-negative men undergoing HIV pre-exposure prophylaxis (PrEP)?
Answer: D. Yearly. The HCV strains they detected were those already circulating among HIV-positive MSM, suggesting that HIV-negative men are at risk of HCV infection due to unprotected sexual intercourse. Current guidelines say that HCV testing should take place at the start of PrEP and at least annually thereafter. However, more frequent testing may be appropriate, depending on the individual’s sexual practices or drug use.
Specific population guidance here.
References: 1. Bourlière M, Gordon SC, Flamm SL, POLARIS-1 and POLARIS-4 Investigators. Sofosbuvir, velpatasvir, and voxilaprevir for previously treated HCV infection. N Engl J Med. 2017;376:2134-2146. 2. Poordad F, Felizarta F, Asatryan A, et al. Glecaprevir and pibrentasvir for 12 weeks for hepatitis C virus genotype 1 infection and prior direct-acting antiviral treatment. Hepatology. 2017;66:389-397.3. Schoenbachler BT, Smith BD, Seña AC, et al. Hepatitis C virus testing and linkage to care in North Carolina and South Carolina jails, 2012â2014. Public Health Rep. 2016;131:98-104.Â
