GT3 HCV Cirrhosis Treatment — SCE Infectious Diseases MCQ

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HardHepatitisGT3 HCV Cirrhosis TreatmentSCE Infectious Diseases

A 45-year-old man with HIV (CD4 300, VL <50 on ART) is diagnosed with genotype 3 hepatitis C with compensated cirrhosis (F4). He is treatment-naive. What is the preferred DAA regimen?

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Correct answer: C — Sofosbuvir/Velpatasvir for 12 weeks plus weight-based Ribavirin

HCV genotype 3 with compensated cirrhosis has the lowest SVR rates among all genotype-fibrosis combinations. For treatment-naive GT3 cirrhotics, Sofosbuvir/Velpatasvir for 12 weeks plus weight-based Ribavirin is the preferred approach to maximise SVR (>95%). Without Ribavirin, SVR rates for GT3 cirrhosis drop to ~85–89%. Glecaprevir/Pibrentasvir for 16 weeks (not 8 weeks — that is for non-cirrhotic) is an alternative but less well-evidenced for GT3 cirrhosis. Drug interactions with ART must be checked.

Reference: EASL 2024 – HCV guidelines; NICE TA499/507; BHIVA 2024 – HCV/HIV