Simplified pan-genotypic hepatitis C treatment suits most patients, but three things must be checked first. Exclude cirrhosis with FIB-4 or elastography, because it changes regimen, duration and the need for liver cancer surveillance. Test HBsAg, because hepatitis B can reactivate during direct-acting antiviral treatment. And review interacting drugs, notably amiodarone with sofosbuvir and acid-suppressants with velpatasvir.
- FIB-4 above 3.25 or liver stiffness above about 12.5 kPa suggests cirrhosis and takes the patient off the simplified pathway.
- Test HBsAg before starting; a positive result needs monitoring or hepatitis B treatment.
- Sofosbuvir with amiodarone can cause serious bradycardia.
- Proton pump inhibitors reduce velpatasvir absorption; check timing and dose rules.
Why it matters
A short, simple course is only safe when the patient genuinely fits the simple pathway.
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