Treatment of chronic hepatitis C (patients without cirrhosis and patients with cirrhosis in the Child-Pugh A surrogate stage) co-infected with HIV should receive the same anti-HCV therapy as patients with HCV alone.
If the cost of each treatment regimen is excluded, interferon-free regimens are the best choice for patients with co-infection with HIV/HCV and HCV alone (patients with cirrhosis without cirrhosis or in Child-Pugh A compensated cirrhosis or patients in decompensated Child-Pugh B or C), with high antiviral activity, good tolerability, and ease of administration.
Treatment of genotype 1 HCV infection
There are six antiviral treatment regimens for people with genotype 1 HCV infection in 2015, including two interferon-containing regimens and four interferon-free regimens. Sofosbuvir in combination with ribavirin is not recommended for patients with genotype 1 HCV infection. In cases where none of the above options have been effective, some patients are interested in PegIFN-α in combination with ribavirin diphtherapy or triple therapy with PegIFN-α in combination with ribavirin plus telaprevir or boceprevir ((Boceprevir) until new affordable direct antivirals become available.
Genotype 1, including interferon regimen 1
Patients with genotype 1 HCV infection can be treated with PEG-IFNα/week in combination with ribavirin (<75 kg: 1000 mg/g, ≥75 kg: 1200 mg/d) and sofosbuvir (Sofosbuvir) 400 mg/d for 12 weeks.
Genotype 1, regimen containing interference 2
Patients with genotype 1 HCV infection can be treated with PEG-IFNα/week in combination with ribavirin (<75kg: 1000mg/g, ≥75kg: 1200mg/d) and simeprevir (Simeprevir) 150mg/d.
Gene sequencing was performed prior to treatment, and this regimen is not recommended for those infected with gene type 1a in which a Q80K substitution in the NS3 protein sequence was detected.
After 12 weeks of triple therapy with simeprevir combined with PegIFN-α and ribavirin in patients with primary treatment, including patients with cirrhosis, and in patients with treated relapses, treatment with PegIFN-α combined with ribavirin should be continued for 12 weeks (total course of 24 weeks); in patients with previous partial virologic response or no response, including patients with cirrhosis, treatment with PegIFN-α combined with ribavirin for 36 weeks (48 weeks total).
HCV RNA levels should be monitored during treatment and the regimen should be discontinued when HCV RNA levels ≥25 IU/ml occur at weeks 4, 12, and 24 of treatment.
Genotype 1, interferon-free regimen 1
Patients with genotype 1 HCV infection may be treated with a combination of interferon-free Sofosbuvir (Sofobuvir:400 mg) and Ledipasvir (Ledipasvir: 90 mg) administered orally daily. In primary and treated patients without cirrhosis, use the appropriate dose combination for 12 weeks, without ribavirin.
In first-treatment patients without cirrhosis, the treatment course should be shortened to 8 weeks if the HCV RNA level is below 6.8log)IU/ml. Caution is needed in regimen adjustment, especially in patients with cirrhosis stage F3, to ensure that the measured HCV RNA is accurate and within a specific range of values, and that the 8-week treatment is adequate to achieve a high rate of sustained viral response.
For patients with primary and treated compensated cirrhosis, 12 weeks of treatment with appropriate doses should be combined with ribavirin (<75 kg: 1000 mg/g, ≥75 kg: 1200 mg/d)
Patients with compensated cirrhosis who have contraindications to ribavirin or who are less well tolerated are treated with an appropriate dose of Sofobuvir in combination with Ledipasvir, without ribavirin for 24 weeks.
In patients with primary compensated cirrhosis and in patients with a negative correlation between efficacy (e.g. platelet count <75 x 103/μl), the course of treatment with Sofobuvir combined with Ledipasvir combined with Ribavirin should be extended to 24 weeks.
Genotype 1, no interferon regimen2
Patients with genotype 1 HCV infection can be treated with an interferon-free regimen with a combination of three drugs, ombitasvir (75 mg), paritaprevir (12.5 mg) and ritonavir (50 mg) (AbbVir: two tablets once daily with a meal), combined with dasabuvir (250 mg) (twice daily, one (one tablet).
Patients with genotype 1b without cirrhosis were treated with this regimen without ribavirin for 12 weeks.
Patients with genotype 1b with cirrhosis need to be treated with ribavirin (<75kg: 1000mg/g, ≥75kg: 1200mg/d). Treatment for 12 weeks.
Patients with genotype 1a with cirrhosis are treated for 24 weeks in combination with ribavirin (<75kg: 1000mg/g, ≥75kg: 1200mg/d).
Genotype 1, no interferon regimen3
Patients with genotype 1 HCV infection can be treated with a 12-week interferon-free regimen of sofosbuvir (sofosbuvir: 400 mg/d) in combination with simeprevir (simeprevir: 150 mg/d).
Based on previous data, the combination of ribavirin (<75 kg: 1000 mg/g, ≥75 kg: 1200 mg/d) is recommended for patients with concomitant cirrhosis.
For patients with cirrhosis who have a contraindication to ribavirin, an extended treatment course of 24 weeks is recommended.
Genotype 1, no interferon regimen4
Patients with genotype 1 HCV infection can be treated with a 12-week course of sofosbuvir (sofosbuvir: 400 mg/d) in combination with daclatasvir (daclatasvir: 60 mg/d) interferon-free regimen.
Based on previous data, the combination of ribavirin (<75 kg: 1000 mg/g, ≥75 kg: 1200 mg/d) is recommended for patients with concomitant cirrhosis. For patients with cirrhosis who have a contraindication to ribavirin, an extended treatment course of 24 weeks is recommended.
Antiviral therapy in patients with genotype 2 HCV infection
The first-line regimen for antiviral therapy in patients with genotype 2 HCV infection is interferon-free sofosbuvir in combination with ribavirin. A small subset of people who fail this regimen may be effective on some other regimens. If these drugs are not available, PegIFN-α in combination with ribavirin may still be used as a treatment option. See the EASL clinical practice guidelines for details.
Genotype 2, Option 1
Patients with genotype 2 HCV infection are given ribavirin (<75 kg: 1000 mg/g, ≥75 kg: 1200 mg/d) in combination with sofosbuvir (sofosbuvir: 400 mg/d) for a 12-week course. In patients with concomitant cirrhosis, especially in patients with treated cirrhosis, the course of therapy should be extended to 16 or 20 weeks.
Genotype 2, regimen 2
Regardless of whether treated or not, patients with cirrhosis can be treated with a triple regimen of PegIFN-α, ribavirin combined with sofosbuvir, ribavirin (<75 kg: 1000 mg/g, ≥75 kg: 1200 mg/d), and sofosbuvir (sofosbuvir: 400 mg/d) for a course of 12 weeks.
Genotype 2, regimen 3
Regardless of whether treated or not, patients with cirrhosis can be treated with an interferon-free regimen of sofosbuvir (sofosbuvir: 400 mg/d) combined with daclatasvir (daclatasvir: 60 mg/d) for 12 weeks.
Antiviral therapy for patients with genotype 3 HCV infection
There are three antiviral treatment regimens for patients with genotype 3 HCV infection. Sofosbuvir in combination with ribavirin is the most desirable regimen, especially in patients with cirrhosis who have failed interferon and ribavirin therapy. (Latest American Liver Association report of 100% efficacy of sofosbuvir + dacarb + ribavirin. 12/15/15 note)
Antiviral therapy for patients with genotype 4 HCV infection
In 2015, there are 6 regimens available for antiviral therapy in patients with genotype 4 HCV infection, including 2 regimens combined with interferon and 4 regimens without interferon, and PegIFN-α combined with ribavirin is still available if the above drugs are not available.
Antiviral therapy for patients with genotype 5 or 6 HCV infection
There are three regimens available for antiviral therapy in patients with genotype 5 and 6 HCV infection: triple therapy with PegIFN-α, ribavirin in combination with sofosbuvir, interferon-free sofosbuvir in combination with Ledipasvir or sofosbuvir in combination with daclatasvir. daclatasvir). If these drugs are not available, PegIFN-α in combination with ribavirin may still be used.
Indications for discontinuation
Patients receiving triple therapy with PegIFN-α, ribavirin, and simeltamivir should discontinue the regimen at weeks 4, 12, and 24 after treatment with an HCV RNA level ≥ 25 IU/ml and immediately switch to another regimen with interferon or an interferon-free regimen without protease inhibitors. There are no clear indications for discontinuation of other regimens.