| Invited Lecture(JSH) |
| Thu. November 21st 9:00 - 9:30 Room 4: Portopia Hotel South Wing Portopia Hall |
| New paradigm of HCV treatment | |||
| Nezam Afdhal | |||
| Division of Gastroenterology/Liver Center, Beth Israel Deaconess Medical Center | |||
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| The introduction of novel all oral therapies for HCV have changed the global approach to HCV treatment since 2013. The initial oral therapies had genotype specific response rates of up to 90% SVR but were also associated with significant resistance issues and poor performance in certain genotypes such as GT3. The advent of the pan-genotypic regimens of sofosbuvir / velpatasvir and glecaprevir / pribentasvir has resulted in both a simplified regimen and a significant reduction in risk of either resistance or failure and SVR rates of 98% are achievable in clinical practice. Moreover, salvage regimens for DAA failures in particular sofosbuvir / velpatasvir/ voxilaprevir have even further clarified the treatment algorithm. These new pan-genotypic DAA’s have changed the treatment paradigm so that genotyping is no longer essential, on treatment monitoring is unnecessary, treatment duration can be fixed and no more than 12 weeks for most patients and even disease staging is not absolutely required although knowledge of the presence of cirrhosis is still recommended. The utilization of DAA in the elderly does require a full clinical evaluation of drug-drug interactions particularly for patients on polypharmacy and when a protease inhibitor is being considered. Data is emerging post-SVR on improved survival, reduced HCC development and a reduction in the need for liver transplant showing the impact of DAA treatment in just 4 years. Controversy exists on risk of HCC progression on DAA but the majority of studies show little risk. Extension of therapy to different patient types previously untreatable include Child’s B and C patients, prisoners, active IVDU patients and acute HCV. Finally, the new paradigm has led to the development of multiple global eradication efforts for HCV in both developed and developing countries utilizing novel detection and treatment strategies |
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