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Monitoring of Patients on HCV Treatment

This document provides detailed guidelines for monitoring patients receiving HCV treatment, including recommended labs before and during treatment, monitoring for side effects, HCV RNA testing, ribavirin precautions, managing treatment failures, and follow-up protocols post-treatment.

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Monitoring of Patients on HCV Treatment

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  1. Monitoring of Patients on HCV Treatment Curtis Barry, MD UMASS ECHO 2/24/17

  2. Disclosure • I have no conflicts of interest related to this subject • Reference: AASLD GUIDELINES

  3. Prior to Starting • Following labs recommended within 12 weeks prior to starting on treatment • CBC, INR • LFTs • Cr • Assess for HBV coinfection with HBsAg, anti-Hbs, and anti-HBc

  4. During treatment • At week 4: CBC, Cr, LFTs • If on ribavirin: monitor CBC as clinically indicated If 10x increase in ALT at week 4 -> stop If increase in ALT plus weakness, n/v, jaundice, increase in INR -> stop Asymptomatic increase in ALT at week 4 -> repeat at weeks 6 and 8.

  5. HCV RNA • Recommended: HCV PCR at week 4 and at 12 weeks following tx • Optional: HCV PCR at end of treatment and 24 weeks following tx

  6. Discontinuation for lack of efficacy • If HCV RNA detectable at week 4 -> repeat week 6. If HCV RNA has increased by greater than 10-fold (>1log10 IU/mL) on repeat testing discontinue HCV treatment • Significance of positive HCV RNA at week 4 that remains positive, but lower, at week 6 or 8 is unknown. No recs on stopping or extending therapy can be provided

  7. Ribavirin • Women of childbearing age should be counseled not to become pregnant while receiving riba and for 6 months after stopping • Male partners of women of childbearing age should be cautioned to prevent pregnancy and for up to 6 months after stopping

  8. Tx Failures • Every 6 to 12 months: CBC, INR, LFTs • Screen for HCC if has cirrhosis • Variceal screening if cirrhosis • Evaluation for retreatment as alternative treatments become available

  9. SVR • If no advanced fibrosis no follow-up needed • If cirrhosis: HCC screening, variceal screening • If persistently abnormal LFTs assessment for other causes of liver disease

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