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Chronic Hepatitis C Treatment Monitoring Algorithm

Diagnosis of chronic hepatitis C virus infection

Order:
#84434 Hepatitis C Virus Genotype After
Amplification, Serum
and
#83142 Hepatitis C Virus RNA Detection and
Quantitation by Real-Time PCR, Serum
HCV genotype HCV genotype
2 or 3 1, 4, 5, or 6

Consider liver biopsy Liver biopsy

Fibrosis with Metavir score >2 Minimal or no fibrosis


Start pegylated interferon
or Ishak score >3
(PEG-IFN) + ribavirin treatment

Start pegylated interferon Treatment optional. Continue


After 4 weeks of treatment: repeat
(PEG-IFN) + ribavirin treatment monitoring patient for:
#83142 Hepatitis C Virus RNA Detection n Liver function and
and Quantitation by Real-Time PCR, Serum
biochemistry
for “rapid virologic response” (RVR) n Clinical symptoms

After 4 weeks of treatment: repeat n Consider repeating liver

No detectable HCV RNA #83142 Hepatitis C Virus RNA Detection biopsy in 3-5 years
HCV RNA detected and Quantitation by Real-Time PCR, Serum
for “rapid virologic response” (RVR)
Poor treatment Excellent treatment
tolerance tolerance No detectable HCV RNA
HCV RNA detected
Yes No No Yes
Excellent treatment Additional 8 weeks of
tolerance treatment (12 weeks total)
Additional 12 weeks Additional 20 weeks Additional 44 weeks
of treatment of treatment of treatment No Yes
(16 weeks total) (24 weeks total) (48 weeks total)
After 12 weeks total treatment: repeat
#83142 Hepatitis C Virus RNA Detection
and Quantitation by Real-Time PCR, Serum
for “early virologic response” (EVR)
When treatment ends: repeat
#83142 Hepatitis C Virus RNA Detection Additional 20 weeks Additional 44 weeks
No detectable If <100-fold (<2 log)
and Quantitation by Real-Time PCR, Serum of treatment of treatment
HCV RNA decrease in HCV RNA
for “end-of-treatment (EOT) response” (24 weeks total) (48 weeks total)

Detectable HCV RNA, “Nonresponder”


but >100-fold (>2 log) STOP treatment
See insert
decrease

When treatment ends: repeat


#83142 Hepatitis C Virus RNA Detection Additional 12 weeks
End-of-treatment response and Quantitation by Real -Time PCR, Serum of treatment
for “end-of-treatment (EOT) response” (24 weeks total)

No detectable HCV RNA


HCV RNA detected See insert After 24 weeks total treatment: repeat
#83142 Hepatitis C Virus RNA Detection and
Quantitation by Real-Time PCR, Serum
Responder “Nonresponder”
No detectable HCV RNA
HCV RNA detected

At 24 weeks after end of treatment: repeat Additional 48 weeks of “Nonresponder”


#83142 Hepatitis C Virus RNA Detection treatment (72 weeks STOP treatment
and Quantitation by Real-Time PCR, Serum total treatment)
for “sustained virologic response“ (SVR)

After 72 weeks total treatment: repeat


No detectable HCV RNA #83142 Hepatitis C Virus RNA Detection
HCV RNA detected and Quantitation by Real -Time PCR, Serum
for “end-of-treatment (EOT) response”

Sustained Relapser
virologic See insert
Legend
response (SVR)
achieved
n Real-Time PCR Testing
IFN: interferon or pegylated interferon

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