{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 18, Ep 3 of 3: Hepatitis C","html":"","width":"100%","height":180,"duration":852,"description":"Episode three covers hepatitis C, now a curable disease, and tests the entire workflow of cure: identify the virus, confirm replication, stage the liver, pick the regimen, document cure, then ask the one remaining cancer question. It runs the reflex antibody-then-RNA diagnosis, the two pangenotypic direct-acting antiviral regimens plus the salvage regimen, and a special-populations set built on a few absolute rules. Decompensated cirrhosis forbids protease inhibitors; advanced kidney disease no longer forbids sofosbuvir. It closes on the highest-yield post-cure point: cancer surveillance continues forever in F4 cirrhosis but stops in F3 fibrosis short of cirrhosis.\n \nTopics covered\n\nHepatitis C as a curable disease and the drug classes\nThe reflex antibody-then-RNA diagnostic algorithm\nUniversal screening and the pre-treatment workup\nThe two pangenotypic regimens and the salvage regimen\nSustained virologic response and what cure buys\nDecompensated cirrhosis and the protease-inhibitor rule\nKidney disease, transplant, and pregnancy\nPost-cure cancer surveillance by fibrosis stage\n \n \nKey decisions\n\nDiagnose in two tests in fixed order, the hepatitis C antibody then a reflex RNA, because the antibody persists for life and cannot distinguish active from resolved infection.\nA high-suspicion patient with a negative antibody is not cleared, because the antibody lags viremia by a couple of months, so the RNA confirms acute hepatitis C.\nThe two preferred first-line regimens are pangenotypic: sofosbuvir-velpatasvir for twelve weeks and glecaprevir-pibrentasvir for eight weeks, the eight weeks holding even in treatment-naive compensated cirrhosis.\nSustained virologic response means undetectable RNA twelve weeks after the end of treatment, not twelve weeks of treatment, and that is the trap.\nProtease inhibitors are unsafe in decompensated Child-Pugh B or C cirrhosis, so the regimen there is sofosbuvir-velpatasvir with ribavirin for twelve weeks or without for twenty-four....","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}