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HCV Treatment Naïve with Cirrhosis — RACP Adult Medicine MCQ

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EasyGastroenterologyHCV Treatment Naïve with CirrhosisRACP Adult Medicine

A 50-year-old man with chronic hepatitis C (genotype 1a, treatment-naïve) with compensated cirrhosis (Child-Pugh A, no varices) has an eGFR of 85 mL/min/1.73m². He has no significant drug interactions. What is the most appropriate HCV treatment?

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Correct answer: A — Sofosbuvir/velpatasvir 12 weeks

For treatment-naïve chronic HCV with compensated cirrhosis, sofosbuvir/velpatasvir (pangenotypic DAA) for 12 weeks is a preferred regimen. Glecaprevir/pibrentasvir 8 weeks (without cirrhosis) or 12 weeks (with cirrhosis) is an alternative pangenotypic option. SVR rates exceed 95% across all genotypes. Post-SVR, patients with cirrhosis require ongoing HCC surveillance (6-monthly US ± AFP).

Reference: GESA – 2022 – Hepatitis C Treatment; AASLD/IDSA 2024 HCV