Treatment Plan for Hepatitis C with RNA Level of 3.68 log-10
For a patient with active Hepatitis C infection (RNA level 3.68 log-10), treatment with a pangenotypic direct-acting antiviral (DAA) regimen such as glecaprevir/pibrentasvir for 8 weeks is recommended. 1
Initial Assessment
Before initiating therapy, the following evaluations should be performed:
- Determine liver disease severity using noninvasive assessment of fibrosis
- Complete blood count with platelet count
- Liver function tests
- HCV genotype determination (if available and cost-effective)
- Testing for HBV coinfection (HBsAg and anti-HBc)
- HIV screening
- Assessment of renal function
- Evaluation for potential drug-drug interactions
Treatment Selection
The viral load of 3.68 log-10 (approximately 4,800 IU/mL) indicates active HCV infection requiring treatment. This level is considered a low viral load (<800,000 IU/mL), which may be associated with better treatment outcomes 2.
Recommended Regimens:
First choice: Glecaprevir/pibrentasvir (Mavyret)
- Dosage: 3 tablets once daily with food (total daily dose: glecaprevir 300 mg and pibrentasvir 120 mg)
- Duration: 8 weeks for treatment-naïve patients without cirrhosis 3
Alternative: Sofosbuvir/velpatasvir
- Dosage: 1 tablet once daily
- Duration: 12 weeks
Monitoring During Treatment
- HCV RNA testing at week 4 of treatment to assess early response
- Complete blood count, creatinine, and liver function tests at week 4
- Assessment for adverse effects at each visit
Post-Treatment Follow-up
- HCV RNA testing at 12 weeks after completion of therapy (SVR12) to confirm cure
- If SVR12 is achieved, no further HCV RNA monitoring is required for patients without advanced fibrosis
Special Considerations
For Patients with Cirrhosis
- If compensated cirrhosis is present, treatment duration may need to be extended to 12 weeks depending on the regimen chosen
- Continued surveillance for hepatocellular carcinoma is necessary even after achieving SVR
For Patients with Prior Treatment Experience
- Treatment duration may need to be extended based on prior regimen exposure:
- 12-16 weeks for those previously treated with NS5A inhibitors
- 12 weeks for those previously treated with NS3/4A protease inhibitors
- 8-16 weeks for those previously treated with interferon-based regimens 3
Expected Outcomes
The current DAA regimens achieve SVR rates exceeding 95% in most patient populations. With the patient's low viral load (3.68 log-10), treatment outcomes are likely to be excellent. SVR is considered a definitive cure with >99% likelihood of permanent viral clearance 1.
Potential Pitfalls
- Failure to test for HBV before treatment could lead to HBV reactivation during or after HCV therapy
- Drug-drug interactions can significantly impact treatment efficacy and safety
- Patients with advanced liver disease require continued surveillance for hepatocellular carcinoma even after achieving SVR
- Alcohol consumption during treatment may reduce efficacy and should be avoided
The treatment approach has evolved significantly from older interferon-based regimens that had lower efficacy and more side effects. Current guidelines strongly recommend not delaying treatment, as viral eradication prevents progression to cirrhosis, hepatocellular carcinoma, and death 2, 1.