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Hepatitis C — SCE Infectious Diseases MCQ

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HardHepatitisHepatitis CSCE Infectious Diseases

A 48-year-old woman with a history of IV drug use and chronic HCV presents with new-onset ascites and jaundice. Liver biopsy 2 years ago showed cirrhosis. She has never been treated for HCV. She now has decompensated cirrhosis (Child-Pugh B, MELD 18). HCV genotype is 3. What is the most appropriate treatment approach?

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Correct answer: D — Sofosbuvir/Velpatasvir for 12 weeks plus Ribavirin; assess for liver transplant listing simultaneously

Explanation lettering: C = shown as B · B = shown as C

HCV treatment in decompensated cirrhosis (Child-Pugh B/C) uses interferon-free DAA regimens. For genotype 3 with decompensated cirrhosis, Sofosbuvir/Velpatasvir plus Ribavirin for 12 weeks is recommended. Glecaprevir/Pibrentasvir is contraindicated in Child-Pugh B/C cirrhosis (protease inhibitor hepatotoxicity risk). SVR can stabilise or improve liver function and may avoid the need for transplant. Ribavirin dose requires monitoring for anaemia.

Reference: EASL 2024 – HCV guidelines; NICE TA507 2018 – Sofosbuvir/Velpatasvir