William F. Balistreri, MD

Disclosures

March 22, 2016

In This Article

Special Situations

Genotype 1b With Cirrhosis

The three-DAA (3D) regimen of ombitasvir, paritaprevir (with ritonavir), and dasabuvir without RBV given for 12 weeks demonstrated SVR12 rates of 100% in patients without cirrhosis who were infected with HCV genotype 1b, and 99% in those with HCV genotype 1b infection and compensated cirrhosis when coadministered with RBV for 12 weeks.[18]

Genotype 1 With Severe Renal Impairment

The 3D regimen does not require dose adjustments in patients with renal insufficiency. In phase 3 trials, the 3D regimen with or without RBV was associated with high SVR rates and low rates of discontinuation owing to adverse events in patients with HCV genotype 1.

Pockros and colleagues[19] reported that 3D with or without RBV was well tolerated by patients with stage 4 or 5 chronic kidney disease and HCV genotype 1, with no premature treatment discontinuations. Hemoglobin decreases were managed with RBV interruption, which did not appear to affect efficacy.

Patients With Sickle Cell Disease

HCV in patients with sickle cell disease presents unique challenges, including sickle cell hepatopathy, splenic dysfunction, accelerated fibrosis secondary to anemia, and iron overload. Historical management with pegylated RBV has been associated with fatal hemolysis, severe anemia, and sepsis.

Basu and colleagues[20] treated a subgroup of patients with sickle cell disease. After receiving LDV (90 mg) plus SOF (400 mg) each day for 12 weeks, 92% achieved an SVR. This study demonstrated that this combination is safe and well-tolerated in patients with sickle cell disease and HCV.

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