Question 8 - Hepatitis C Coinfection Question Bank

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Hepatitis C CoinfectionQuestion 8/10

A 63-year-old woman with HIV and chronic hepatitis C virus (HCV) coinfection is being evaluated to start HCV treatment. She has suppressed HIV RNA levels on a regimen of dolutegravir plus tenofovir alafenamide-emtricitabine. She meets all criteria for the simplified HCV treatment. In addition, she is clinically stable and has had no complications related to her cirrhosis. Because her insurance company will only cover sofosbuvir-velpatasvir, an HCV genotype is ordered, and she has HCV genotype 3.

Assuming that she will receive sofosbuvir-velpatasvir for treatment, what is the next recommended step?

Treat with sofosbuvir-velpatasvir for 16 weeks

Treat with sofosbuvir-velpatasvir for 8 weeks

Treat with sofosbuvir-velpatasvir plus ribavirin for 8 weeks

Order NS5A resistance testing

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Question Last Updated
September 29th, 2023

Table 1. **Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV**

Simplified HCV Treatment Regimens in People with HIV
Treatment-Naive Patients Without Cirrhosis
Glecaprevir-pibrentasvir (100 mg/40 mg tablet): three tablets daily for 8 weeks (AI), or Sofosbuvir-velpatasvir (400 mg/100 mg tablet): one tablet daily for 12 weeks (AI)
Treatment-Naive Patients with Compensated Cirrhosis
HCV Genotypes 1, 2, 4, 6
Preferred Therapy Glecaprevir-pibrentasvir (100 mg/40 mg tablet): three tablets daily for 8 weeks (AIII), or Sofosbuvir-velpatasvir (400 mg/100 mg tablet): one tablet daily for 12 weeks (AI) Alternative Therapy Glecaprevir-pibrentasvir (100 mg/40 mg tablet): three tablets daily for 12 weeks (CI)
HCV Genotype 3
Preferred Therapy Glecaprevir-pibrentasvir (100 mg/40 mg tablet): three tablets daily for 8 weeks (AIII) Alternative Therapy Glecaprevir-pibrentasvir (100 mg/40 mg tablet): three tablets daily for 12 weeks (CI), or Sofosbuvir-velpatasvir tablet (400 mg/100 mg tablet): one daily, with or without ribavirin for 12 weeks pending results of NS5A resistance testing (CI)
Treatment of Acute HCV Infection
Glecaprevir-pibrentasvir (100 mg/40 mg tablet): three tablets daily for 8 weeks (AII), or Sofosbuvir-velpatasvi (400 mg/100 mg tablet): one tablet daily for 12 weeks (AII)
Recommendations for treatment after DAA failure are not provided; see the corresponding section in AASLD/IDSA HCV Treatment Guidance

Source:

Panel on Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Hepatitis C virus. Last Updated: January 18, 2023 [HIV.gov]

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Assuming that she will receive sofosbuvir-velpatasvir for treatment, what is the next recommended step?

Simplified HCV Treatment Regimens in People with HIV

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