From the Guidelines
I strongly recommend referring your patient to a hepatitis specialist or gastroenterologist for comprehensive evaluation and treatment, as this approach has been shown to significantly improve morbidity, mortality, and quality of life outcomes in patients with hepatitis C. The current standard treatment for hepatitis C involves direct-acting antiviral medications, which have been demonstrated to be highly effective in achieving a sustained virological response (SVR) and reducing the risk of complications such as cirrhosis, liver failure, and hepatocellular carcinoma 1.
Before starting treatment, your patient will need additional testing to determine the viral genotype, viral load, liver function tests, and assessment of liver fibrosis. It's also important to screen for HIV and hepatitis B co-infection, as these conditions can impact treatment outcomes 1. While awaiting specialist consultation, advise your patient to:
- Avoid alcohol completely, as it can exacerbate liver damage
- Maintain a healthy diet to support liver health
- Avoid sharing personal items that might have blood contact, such as razors and toothbrushes, to prevent transmission to others
- Inform sexual partners about their diagnosis to prevent transmission
These medications work by directly targeting the hepatitis C virus replication machinery, preventing viral reproduction and allowing the body to clear the infection. With modern treatments, hepatitis C is now considered a curable condition for most patients, but early intervention is crucial to prevent progression to cirrhosis, liver failure, or hepatocellular carcinoma 1.
Key considerations in the management of hepatitis C include:
- Access to appropriate medical care, as delays in referral and treatment can impact outcomes
- Education and counseling on disease management and prevention of further liver damage
- Regular monitoring and follow-up to assess treatment response and adjust the treatment plan as needed 1
From the FDA Drug Label
5.1 Risk of Hepatitis B Virus Reactivation in Patients Coinfected with HCV and HBV Hepatitis B virus (HBV) reactivation has been reported in HCV/HBV coinfected patients who were undergoing or had completed treatment with HCV direct acting antivirals, and who were not receiving HBV antiviral therapy.
The patient should be tested for evidence of current or prior HBV infection by measuring HBsAg and anti-HBc before initiating HCV treatment with ledipasvir and sofosbuvir. In patients with serologic evidence of HBV infection, monitor for clinical and laboratory signs of hepatitis flare or HBV reactivation during HCV treatment with ledipasvir and sofosbuvir and during post-treatment follow-up. Initiate appropriate patient management for HBV infection as clinically indicated 2, 2, 3.
From the Research
Treatment Options for Hepatitis C
- The combination of ledipasvir and sofosbuvir has been shown to be effective in treating hepatitis C virus (HCV) genotype 1 infection, with sustained virologic response (SVR) rates of 96% to 97% in treatment-naive patients without cirrhosis 4.
- For patients with HCV genotype 4, ledipasvir and sofosbuvir have also been shown to be effective, with SVR rates of 95% to 100% in treatment-naive patients without cirrhosis 5.
- In patients with advanced liver disease, including those with decompensated cirrhosis, ledipasvir and sofosbuvir plus ribavirin have been shown to be effective, with SVR rates of 87% to 100% 6.
- Real-world studies have also demonstrated the efficacy of ledipasvir/sofosbuvir in HCV genotype 4-infected patients with advanced liver fibrosis and decompensated cirrhosis, with SVR rates of 92.5% 7.
Factors Associated with Treatment Response
- Factors that predict SVR include higher albumin levels, lower total bilirubin levels, absence of cirrhosis, and absence of proton pump inhibitor use 4.
- The addition of ribavirin to ledipasvir and sofosbuvir does not appear to enhance efficacy in patients with HCV genotype 4 7.
- Treatment duration of 12 weeks is effective for most patients, but 24 weeks may be necessary for some patients with cirrhosis or prior treatment failure 4, 6.