From the Guidelines
I strongly recommend scheduling this 64-year-old male prison patient for the next available provider appointment to discuss his HCV status, as undetectable HCV RNA levels do not necessarily indicate complete resolution of liver disease or elimination of all risks associated with HCV infection. The patient has a positive hepatitis C antibody test but an undetectable HCV RNA level (less than 15, not detected), which suggests he either spontaneously cleared the virus or previously received successful treatment that wasn't documented, as indicated by the EASL recommendations on treatment of hepatitis C 1. During the appointment, the provider should review the patient's complete medical history to determine if he received undocumented HCV treatment in the past, assess for any current liver disease, and consider ordering additional tests such as liver function tests, a complete blood count, and possibly liver fibrosis assessment (FibroScan or FibroTest if available).
- Key aspects to consider during the appointment include:
- Review of medical history for undocumented HCV treatment
- Assessment for current liver disease
- Ordering of additional tests (liver function tests, complete blood count, liver fibrosis assessment)
- Screening for other conditions common in patients with a history of HCV (hepatitis B, HIV, alcohol use disorder) Even with undetectable HCV RNA, the patient may have residual liver damage from prior infection that requires monitoring, as achieving a sustained virological response (SVR) is associated with normalization of liver enzymes and improvement or regression of liver necroinflammation and fibrosis, but does not eliminate the risk of hepatocellular carcinoma (HCC) or liver-related mortality, especially in patients with cirrhosis or cofactors of liver morbidity 1. The provider should also consider the patient's overall health and potential extra-hepatic manifestations associated with HCV infection, and develop a plan for ongoing monitoring and care to reduce all-cause mortality and improve quality of life.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
HCV Treatment and Patient Outcomes
- The patient has a positive HCV antibody test and an HCV RNA level of < 15 ND, indicating a low viral load 2, 3.
- There is no documentation of previous HCV treatment, so the patient may be a candidate for initial treatment 4, 5.
- Studies have shown that treatment with sofosbuvir and velpatasvir can achieve high rates of sustained virological response (SVR) in patients with HCV infection, including those with compensated and decompensated cirrhosis 2, 3, 4, 5.
Treatment Options and Efficacy
- Sofosbuvir and velpatasvir have been shown to be effective in treating HCV infection in patients with and without cirrhosis, with SVR rates ranging from 92% to 100% 2, 3, 4, 5.
- The treatment duration is typically 12 weeks, but an 8-week treatment regimen has also been shown to be effective in patients with acute HCV monoinfection 6.
- Patient-reported outcomes, such as quality of life and fatigue, have been shown to improve with treatment, especially in patients with decompensated cirrhosis 5.
Next Steps
- The patient should be scheduled for a provider appointment to discuss treatment options and determine the best course of action based on their individual needs and medical history.
- The provider will likely recommend treatment with sofosbuvir and velpatasvir, and will monitor the patient's response to treatment and adjust the treatment plan as needed 2, 3, 4, 5, 6.