..

2559
Thailand Practice Guideline for Management of Chronic Hepatitis C 2016
anti-HCV
o HCV RNA
HCV RNA 15 IU/mL
o HCV RNA HCV RNA 3-6
HCV RNA (false positive)

HCV RNA

- (Liver Function Test; LFT),

CBC, coagulogram
- HBsAg, anti-HBc, HIV Ab HAV Ab
-
-
- (HCV genotype)
HCV RNA anti-HCV
(acute hepatitis C)
HIV

o significant fibrosis
-
Metavir 2
- transient elastography 7.0
kPascal

- (acoustic radiation force

impulse imaging) 1.2
- -2-macroglobulin, GGT, apolipoprotein A1,
haptoglobin total bilirubin
Fibrotest 0.48
o
-
-
Metavir 4
- transient elastography
13 kPascal
- (acoustic radiation force
impulse imaging) 1.8
- -2-macroglobulin, GGT, apolipoprotein A1,
haptoglobin total bilirubin
Fibrotest 0.74

o


o
o

o (decompensated cirrhosis)
o (significant fibrosis) Metavir 3
F3

o
o
o
o
o

HIV
HBV

HCV
(extra-hepatic manifestations)

o (significant fibrosis) Metavir 2
F2
o HCV
-
-

o Metavir 0-1


- Pegylated interferon alfa 2a 2b
- Ribavirin
- Boceprevir
- Sofosbuvir
- Daclatasvir
- simeprevir sofosbuvir
ledipasvir paritaprevir/ritonavir ombitasvir dasabuvir


pegylated interferon ribavirin

1
o
1: pegylated interferon ribavirin
2 sofosbuvir 400
12
2: sofosbuvir 400 daclatasvir
60 12
3: sofosbuvir 400 ledipasvir
90 12
8 1b HCV RNA
6,000,000 IU/mL
4: sofosbuvir 400 simeprevir
150 12
: simeprevir 1a Q80k variant
5: paritaprevir 150 ritonavir
100 ombitasvir 25 dasabuvir
250 2 ) 12
: ribavirin 2 1a
o
1: pegylated interferon ribavirin
2 sofosbuvir 400
12

 2: sofosbuvir 400 daclatasvir

60 ribavirin 2
12
ribavirin 24
3: sofosbuvir 400 ledipasvir
90 ribavirin 2
12
ribavirin 24
4: sofosbuvir 400 simeprevir
150 ribavirin 2
12
ribavirin 24
5: paritaprevir 150 ritonavir 100
ombitasvir 25 dasabuvir 250
2 ribavirin 2 12
1b 24 1a
2
o
1: pegylated interferon ribavirin
2 sofosbuvir 400
12
2: sofosbuvir 400 daclatasvir
60 12
3: sofosbuvir 400 ribavirin
2 12 16-24

 3
o
1: pegylated interferon ribavirin
2 sofosbuvir 400
12
2: sofosbuvir 400 ribavirin
2 24
3: sofosbuvir 400 daclatasvir
60 12
o
1: pegylated interferon ribavirin
2 sofosbuvir 400
12
2: sofosbuvir 400 daclatasvir
60 ribavirin 1,000-1,200
2 16-24
: 12 F3 fibrosis
4
o
1: pegylated interferon ribavirin
2 sofosbuvir 400
12
2: sofosbuvir 400 daclatasvir
60 12

 3: sofosbuvir 400 ledipasvir

90 12
4: sofosbuvir 400 simeprevir
150 12
o
1: pegylated interferon ribavirin
2 sofosbuvir 400
12
2: sofosbuvir 400 daclatasvir
60 ribavirin 2
12
ribavirin 24
3: sofosbuvir 400 ledipasvir
90 ribavirin 2
12
ribavirin 24
4: sofosbuvir 400 simeprevir
150 ribavirin 2
12
ribavirin 24

 5 6
o
1: pegylated interferon ribavirin
2 sofosbuvir 400
12
2: sofosbuvir 400 daclatasvir
60 12
3: sofosbuvir 400 ledipasvir
90 12
o
1: pegylated interferon ribavirin
2 sofosbuvir 400
12
2: sofosbuvir 400 daclatasvir
60 ribavirin 2
12
ribavirin 24
3: sofosbuvir 400 ledipasvir
90 ribavirin 2
12
ribavirin 24


o
No cirrhosis
G1a
G1b
G2

SOF/Peg/RBV
12 wk

SOF/RBV

SOF/LDV
8-12 wk

AbbVies
12 wk + RBV
12 wk

SOF/SMP
12 wk

12 wk

12 wk

12 wk

G3

12 wk

24 wk

12 wk

G4

12 wk

12 wk

G5/6

12 wk

12 wk

12 wk

SOF/DCV
12 wk

12 wk
12 wk

o
Cirrhosis
G1a
G1b
G2

SOF/Peg/RBV
12 wk

SOF/RBV

12 wk

16-20 wk

G3

12 wk

G4

12 wk

G5/6

12 wk

SOF/LDV
24 wk
12 wk + RBV

24 wk
12 wk + RBV
24 wk
12 wk + RBV

AbbVies
24 wk + RBV
12 wk + RBV

SOF/SMP
24 wk
12 wk + RBV

24 wk
12 wk + RBV

SOF/DCV
24 wk
12 wk + RBV
12 wk
16-24 wk +
RBV
24 wk
12 wk + RBV
24 wk
12 wk + RBV

: pegylated interferon / ribavirin

o pegylated interferon alfa-2a 180
1
ribavirin
- 1,000 75
- 1,200 75
o pegylated interferon alfa-2b 1-1.5
1 1
ribavirin
- 800 65
- 1,000 65 85
- 1,200 85 105
- 1,400 105
o ribavirin pegylated interferon
ribavirin pegylated interferon alfa-2a
interferon ribavirin
- (decompensated cirrhosis)
- interferon / ribavirin
-
-
-
- interferon
-

 1 boceprevir
1: sofosbuvir 400 daclatasvir
60 ribavirin 2
12
24 (F3 fibrosis)
2: sofosbuvir 400 ledipasvir
90 ribavirin 2
12
24 (F3 fibrosis)
3: sofosbuvir 400 simeprevir
150 ribavirin 2
12
24 (F3 fibrosis)
4: paritaprevir 150 ritonavir 100
ombitasvir 25 dasabuvir 250
2 ) ribavirin 2 12
24 (F3 fibrosis)


(decompensated cirrhosis)
- Child-Pugh score 13-15
- Child-Pugh score < 12

o 1, 4 6
1: sofosbuvir 400 daclatasvir
60 ribavirin 2
12
ribavirin 24
ribavirin 600 200

2: sofosbuvir 400 ledipasvir

90 ribavirin 2
12
ribavirin 24
ribavirin 600 200

3: sofosbuvir 400 simeprevir

150 daclatasvir 60
12

o 2 3
1: sofosbuvir 400 ribavirin
2 24
2: sofosbuvir 400 daclatasvir
60 ribavirin 2
12
ribavirin 24
HIV
-
HIV
- HCV
HIV hep druginteraction

-

- HBV DNA
HBV DNA 2000 IU/mL

- (Glomerular Filtration Rate; GFR
30 /)

- (GFR 30 /)
(direct acting antiviral, DAA) simeprevir daclatasvir
paritaprevir/ritonavir paritaprevir ombitasvir

dasabuvir sofosbuvir
GFR 30 /
o 2, 3, 5 6
-

-
(compensated cirrhosis) pegylated interferon alfa-2a
135 1 pegylated
interferon alfa-2b 1 1
1
- ribavirin

o 1 4
o
- Daclatasvir 60 asunaprevir 200 2
12
: 1b
80,000 cell/mm
-
paritaprevir 150 ritonavir 100
ombitasvir 25 dasabuvir 250
2 ribavirin 2

12

o
- (compensated cirrhosis)
pegylated interferon alfa-2a 135
1 pegylated interferon alfa-2b
1 1 1 ribavirin

-
(decompensated cirrhosis)

-


o
- sofosbuvir 400
ribavirin 2

-

3-6 direct
acting antiviral (DAA) drugs DAA
(drug interaction)
DAA
DAA 12

o 1, 4 6
1: sofosbuvir 400 daclatasvir
60 ribavirin 2
12
ribavirin 24
2: sofosbuvir 400 ledipasvir
90 ribavirin 2
12
ribavirin 24
3: sofosbuvir 400 simeprevir
150 ribavirin 2
12
ribavirin 24
o 2
sofosbuvir 400 ribavirin
2 12-24
o 3
1: sofosbuvir 400 daclatasvir
60 ribavirin 2
12-24
2: sofosbuvir 400 ribavirin
2 24

 (acute hepatitis C)
o HCV RNA 12-16
- HCV RNA

- HCV RNA pegylated interferon
(direct acting antiviral, DAA)
12 ribavirin