Post Liver Transplant

  1. G1
    1. Viekira Pak [Paritaprevir/r + Ombitasvir daily fixed dose combination + Dasabuvir twice daily dose + RBV BID] [with food] for 24 weeks –> 97% SVR12 [Coral 1] [Escalating dose of RBV – Initial dose most commonly 600-800 mg daily]

 

  1. G1 & 4
    1. Harvoni [LDV/SOF daily fixed dose combination] 1 tab daily + RBV WBD BID for 12 weeks –> 96% SVR12 & for 24 weeks –> 96% SVR12 (SOLAR-1) [CIRRHOTICS -Escalating dose of RBV – Initial dose most commonly 600-800 mg daily] [Decompensated cirrhosis CTP Class B – 85% SVR12 [12 and 24 weeks] and Decompensated cirrhosis CTP Class C – 60% SVR12 [12 and 24 weeks] [Mortality rate 10% among patients with CTP class B or C cirrhosis]
    2. SOF 400MG QD + DCV 60 MG QD + RBV [INITIAL DOSE OF 600 MG DAILY, INCREASED AS TOLERATED] for 12 weeks –> 91% SVR12 (ALLY-1)
    3. Harvoni [LDV/SOF daily fixed dose combination] 1 tab daily for 24 weeks –> 98% SVR12 (SOLAR-2) [ANEMIA + RBV INTOLERANCE]
    4. SOF 400MG QD + DCV 60 MG QD for 24 weeks –> 87% SVR12 (Fontana 2015) [ANEMIA + RBV INTOLERANCE]

 

  1. G2 Compensated Cirrhosis
    1. SOF 400MG QD + DCV 60 MG QD + RBV [INITIAL DOSE OF 600 MG DAILY, INCREASED AS TOLERATED] for 12 weeks –> ?% SVR12
    2. SOF 400MG QD + DCV 60 MG QD for 24 weeks –> ?% SVR12– RBV Ineligible

 

  1. G3 Compensated Cirrhosis
    1. SOF 400MG QD + DCV 60 MG QD + RBV [INITIAL DOSE OF 600 MG DAILY, INCREASED AS TOLERATED] for 12 weeks –> ?% SVR12
    2. SOF 400MG QD + DCV 60 MG QD for 24 weeks –> ?% SVR12– RBV Ineligible

 

 

Clinic Visits & Labs                                                                                                                      

  1. Initiation of Therapy
  2. Week 2 – CBC, CMP
  3. Week 4 – CBC, CMP, HCV RNA PCR quantitative [hCG with RBV]
  4. Week 8 – CBC, CMP
  5. Week 12 – CBC, CMP, HCV RNA PCR quantitative [hCG with RBV]
  6. Week 4 Post Therapy – CBC, CMP, HCV RNA PCR quantitative [hCG with RBV]
  7. Week 12 Post Therapy – CBC, CMP, HCV RNA PCR quantitative [hCG with RBV] – SVR12

*** 24 weeks duration therapy

  • Monthly labs after week 12 – CBC & CMP
  • Week 24 HCV RNA PCR quantitative [hCG with RBV]

 

Viekira Pak = Paritaprevir [150 mg]/r [100 mg] (NS3/4A protease inhibitor + ritonavir) + Ombitasvir [25 mg] (NS5A inhibitor) + Dasabuvir [250 mg] (non-nucleoside NS5B polymerase inhibitor) ± RBV WBD

SOF = Sofosbuvir [Sovaldi] [400 mg daily] – NS5B nucleotide analog polymerase inhibitor

RBV = Ribavirin [RIBAPAK/MODERIBA/RIBAVIRIN] [Weight <75 kg – 1000 mg daily; >75 kg – 1200 mg daily] [Escalating dose of RBV – Initial dose most commonly 600-800 mg daily]

LDV = Ledipasvir [90 mg daily] – NS5A inhibitor

DCV = Daclatasvir [60 mg daily] [DAKLINZA] – NS5A inhibitor

 

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