214.3 🩺 內科專科考前版

214.3.0.1 1️⃣ WHO 2030 Elimination Strategy

• 90% diagnosis
• 80% treatment access
• 65% mortality reduction
• Achievable with mass screening + universal DAA access
• Egypt achieved national elimination 2024 (90+ % cured)
• Australia, Iceland, Japan on track
• Challenges: USA + lower-middle income

214.3.0.2 2️⃣ Egypt Story

• Iatrogenic HCV from schistosomiasis treatment campaigns (1960s-80s)
• Pre-DAA prevalence ~ 10% (~ 6M chronic)
• 2014: mass DAA treatment program initiated
• 2024: WHO confirmed national elimination
• Model for global elimination

214.3.0.3 3️⃣ HCV + HIV Co-Infection

• Drug interaction important
• DAA + ART careful selection
• Many ART regimens compatible
• Specific issues:
  • Glecaprevir + boosted darunavir/ritonavir (significant interaction)
  • Sofosbuvir more universally compatible
• Liverpool HEP interaction tool

214.3.0.4 4️⃣ DAA Resistance

• Rare in modern era (95%+ SVR)
• Failures: often related to:
  • Adherence
  • Cirrhosis (slightly lower SVR)
  • Genotype 3 (with cirrhosis)
  • Prior DAA exposure (RAS)
• Salvage: Vosevi (sofosbuvir/velpatasvir/voxilaprevir) effective in most
• Phenotypic resistance testing rarely needed

214.3.0.5 5️⃣ HCC Surveillance Post-Cure

• Cirrhotic HCV patients cured with DAAs still have HCC risk (residual risk decreases but persists)
• Continue surveillance (US + AFP q6 mo) lifelong if cirrhosis
• Non-cirrhotic cured: surveillance not routine

214.3.0.6 6️⃣ Decompensated Cirrhosis + DAAs

• Improvement in liver function with HCV cure (~ 30-50% Child B → A reduction)
• Some bridge to transplant
• Avoid protease inhibitors (glecaprevir, voxilaprevir) in Child C (hepatotoxicity)
• Sofosbuvir/velpatasvir + RBV × 12-24 wk preferred

214.3.0.7 7️⃣ MSM + HCV (Especially HIV+)

• “Chemsex” associated outbreaks
• Repeat infection / reinfection common after cure
• PrEP discussion (HIV)
• HCV monitoring annually in MSM HIV+
• Doxy-PEP discussion

214.3.0.8 8️⃣ Pediatric HCV

• Approved DAAs:
  • Mavyret 3+ yr
  • Epclusa 6+ yr
  • Harvoni 3+ yr
• Treatment routine recommended (not waited until adulthood as historically)
• Counseling family

214.3.0.9 9️⃣ 健保 / Taiwan

• 健保 DAAs covered for HCV
• Universal access since 2017
• Taiwan elimination program — significant progress
• Birth cohort screening (1965-89)
• 通報

214.3.0.10 10. Vaccine Future

• Chimpanzee adenovirus + MVA prime-boost (Phase 1-2)
• Subunit vaccines in trial
• Polyclonal mAb / vaccinated convalescent plasma research
• Difficult target but progress ongoing

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