From the Guidelines
The hepatitis C viral load of 2,520,000 IU indicates active HCV infection with significant viral replication, and the recommended treatment would be a direct-acting antiviral (DAA) regimen such as Epclusa (sofosbuvir/velpatasvir) 400mg/100mg once daily for 12 weeks, or Mavyret (glecaprevir/pibrentasvir) 300mg/120mg (three tablets) once daily with food for 8 weeks in treatment-naïve patients without cirrhosis, as supported by the most recent and highest quality study 1.
The high viral load confirms chronic hepatitis C infection and suggests the need for antiviral treatment. Before starting treatment, additional testing is needed including:
- HCV genotype determination
- Liver fibrosis assessment
- Screening for hepatitis B and HIV co-infections
Treatment decisions should be individualized based on these factors, potential drug interactions, and comorbidities. DAAs work by targeting specific steps in the HCV replication cycle, achieving cure rates exceeding 95% with minimal side effects, as reported in the study 1. Regular monitoring during treatment and a sustained virologic response check 12 weeks after completing therapy will confirm cure.
The goals of hepatitis C treatment are to eradicate HCV and to prevent complications of liver cirrhosis, hepatocellular carcinoma, extrahepatic manifestations of HCV infection and death, as stated in the guidelines 1. The short-term goal of hepatitis C treatment is to achieve an SVR, defined as undetectable serum HCV RNA by a sensitive assay 12 or 24 weeks after the end of treatment.
In patients with recently acquired hepatitis C, the ideal duration of treatment remains unknown, but high SVR rates have been reported with DAA-based regimens, as shown in the study 1. The combination of sofosbuvir and velpatasvir administered for 12 weeks yielded a 95% SVR rate in patients with recently acquired hepatitis C.
Therefore, the most effective treatment approach for a patient with a hepatitis C viral load of 2,520,000 IU would be to initiate a DAA regimen, such as Epclusa or Mavyret, for 12 weeks, with regular monitoring and follow-up to confirm cure, as supported by the most recent and highest quality study 1.
From the Research
HEP. C RNA Treatment
- The patient has a HEP. C RNA level of 2520000 IU/mL, which is below the 6 million IU/mL threshold for an 8-week regimen of ledipasvir and sofosbuvir for treatment-naïve patients without cirrhosis 2.
- Studies have shown that ledipasvir and sofosbuvir are highly effective for a broad spectrum of patients with HCV genotype 1 infection, with sustained virologic response rates 12 weeks after treatment (SVR12) of 96-98% 2, 3.
- Factors that predict SVR12 include higher albumin levels, lower total bilirubin levels, absence of cirrhosis, and absence of proton pump inhibitor use 2.
- Other treatment options, such as glecaprevir and pibrentasvir, have also shown high virological efficacy and can be used for patients with severe chronic kidney disease or prior treatment failure to antiviral regimens containing other DAAs 4, 5.
- Real-world studies have demonstrated the effectiveness of these treatments, with SVR12 rates of 90-100% for patients with mixed HCV genotype infections 5.
Treatment Options
- Ledipasvir and sofosbuvir for 8 weeks may be a suitable treatment option for this patient, given their HEP. C RNA level and the potential for high SVR12 rates 2.
- Glecaprevir and pibrentasvir may also be considered, particularly if the patient has comorbidities such as advanced stage CKD or prior treatment failure to antiviral regimens containing other DAAs 4, 5.
- The choice of treatment should be based on individual patient factors, including their HCV genotype, presence of cirrhosis, and other comorbidities, as well as the potential for drug interactions and side effects 2, 3, 4, 5.