Identifying people living with HCV
In the United States alone, 2.3 million adults are infected with the hepatitis C virus2
HCV is largely asymptomatic
Most people with chronic HCV infection have nonspecific symptoms such as chronic fatigue and depression3
HCV infection often becomes chronic3
75%-85%
of patients will
develop chronic infection
10%-20%
will develop cirrhosis
over a period of 20-30 years
Prevalence trends: baby boomers and new cases of HCV
~1/2 of individuals with
HCV are baby boomers5
(born between 1945 and 1965)
New HCV infections are rapidly increasing among 6,7:
Who should be tested for HCV?
AASLD & IDSA Guideline recommendations for one-time hepatits C testing8:
RECOMMENDATIONS |
|---|
| One-time, routine, opt-out HCV testing is recommended for all individuals aged 18 years and older. |
| One-time HCV testing should be performed for all persons less than 18 years old with behaviors, exposures, or conditions or circumstances associated with an increased risk of HCV infection (see below). |
Periodic repeat HCV testing should be offered to all persons with behaviors, exposures, or conditions or circumstances associated with an increased risk of HCV exposure (see below). |
| Annual HCV testing is recommended for all persons who inject drugs and for HIV-infected men who have unprotected sex with men. |
Risk behaviors8:
- Injection drug use (current or ever, including those who injected only once)
- Intranasal illicit drug use
- Men who have sex with men
Risk exposures8:
- Persons on long-term hemodialysis (ever)
- Persons with percutaneous/parenteral exposures in an unregulated setting
- Healthcare, emergency medical, and public safety workers after needlestick, sharps, or mucosal exposure to HCV-infected blood
- Children born to HCV-infected women
- Prior recipients of a transfusion or organ transplant, including persons who:
- Were notified that they received blood from a donor who later tested positive for HCV
- Received clotting factor concentrates produced before 198
- Received a transfusion of blood or blood components, or underwent an organ transplant before July 1992.
- Persons who were ever incarcerated
Risk conditions and circumstances8:
- HIV infection
- Unexplained chronic liver disease including elevated alanine aminotransferase (ALT) levels
- Sexually active persons about to start pre-exposure prophylaxis (PrEP) for HIV
- Solid organ donors (living and deceased) and solid organ transplant recipients
Refer to AASLD/IDSA guidelines for further details.
CDC recommendations for HCV testing9
Recommended testing sequence for identifying current HCV infection
*For persons who might have been exposed to HCV within the past 6 months, testing for HCV RNA or follow-up testing for HCV antibody is recommended. For persons who are immunocompromised, testing for HCV RNA can be considered.
†To differentiate past, resolved HCV infection from biologic false positivity for HCV antibody, testing with another HCV antibody assay can be considered. Repeat HCV RNA testing if the person tested is suspected to have had HCV exposure within the past 6 months or has clinical evidence of HCV disease, or if there is concern regarding the handling or storage of the test specimen.
INDICATION1
MAVYRET is indicated for the treatment of adult and pediatric patients 12 years and older or weighing at least 45 kg with chronic hepatitis C virus (HCV) genotype 1, 2, 3, 4, 5, or 6 infection without cirrhosis or with compensated cirrhosis (Child-Pugh A). MAVYRET is indicated for the treatment of adult and pediatric patients 12 years and older or weighing at least 45 kg with HCV genotype 1 infection, who previously have been treated with a regimen containing an HCV NS5A inhibitor or an NS3/4A protease inhibitor (PI), but not both.
IMPORTANT SAFETY INFORMATION1
WARNING: RISK OF HEPATITIS B VIRUS REACTIVATION IN PATIENTS COINFECTED WITH HCV AND HBV: Test all patients for evidence of current or prior hepatitis B virus (HBV) infection before initiating treatment with MAVYRET. HBV reactivation has been reported in HCV/HBV coinfected patients who were undergoing or had completed treatment with HCV direct-acting antivirals and were not receiving HBV antiviral therapy. Some cases have resulted in fulminant hepatitis, hepatic failure, and death. Monitor HCV/HBV coinfected patients for hepatitis flare or HBV reactivation during HCV treatment and post-treatment follow-up. Initiate appropriate patient management for HBV infection as clinically indicated.
CONTRAINDICATIONS
- MAVYRET is contraindicated in patients with moderate or severe hepatic impairment (Child-Pugh B or C) or those with any history of prior hepatic decompensation.
- MAVYRET is contraindicated with atazanavir or rifampin.
WARNINGS AND PRECAUTIONS
Risk of Hepatic Decompensation/Failure in Patients with Evidence of Advanced Liver Disease
- Postmarketing cases of hepatic decompensation/failure, some fatal, have been reported in patients treated with HCV NS3/4A protease inhibitor-containing regimens, including MAVYRET. The median time to onset for MAVYRET was 27 days. The majority had moderate or severe hepatic impairment prior to initiating therapy, including some with compensated cirrhosis at baseline but with a prior decompensation event. Rare cases were reported in patients without cirrhosis or with compensated cirrhosis; many of these patients had evidence of portal hypertension. In patients with compensated cirrhosis or evidence of advanced liver disease, perform hepatic laboratory testing as clinically indicated; and monitor for signs and symptoms of hepatic decompensation such as the presence of jaundice, ascites, hepatic encephalopathy, and variceal hemorrhage. Discontinue MAVYRET in patients who develop evidence of hepatic decompensation/failure.
Risk of Reduced Therapeutic Effect Due to Concomitant Use of MAVYRET with Certain Drugs
- Carbamazepine, efavirenz, and St. John’s Wort may significantly decrease plasma concentrations of glecaprevir and pibrentasvir, leading to reduced therapeutic effect of MAVYRET. The use of these agents with MAVYRET is not recommended.
ADVERSE REACTIONS
Most common adverse reactions observed with MAVYRET:
- >10% of subjects: headache and fatigue
US-MAVY-190705