Treatment of fibrosing cholestatic hepatitis C

As it is now recommended to treat patients either before or shortly after liver transplantation, FCH should rarely be observed after liver transplantation. If it does occur, diagnosis of FCH should be made according to established criteria.[85] Treatment with DAAs results in rapid clinical improvement and high rates of SVR. Clinical trial data evaluating the efficacy of DAAs are limited, but available data are encouraging.[69],[86] In the absence of prospective clinical trials, we recommend people with FCH be treated with regimens recommended for people after liver transplantation, according to whether liver disease is compensated or decompensated (Tables 6 and 7).

Table 7. Recommended treatment protocols after liver transplantation for hepatitis C virus (HCV) infection in people with compensated liver disease

Regimen

HCV genotype

Duration

Sofosbuvir 400 mg, orally, daily

+

Velpatasvir 100 mg, orally, daily

1–6

12 weeks

Glecaprevir 300 mg, orally, daily

+

Pibrentasvir 120 mg, orally, daily

1–6

12 weeks

Sofosbuvir 400 mg, orally, daily

+

Velpatasvir 100 mg, orally, daily

+

Voxilaprevir 100 mg, orally, daily

1–6

12 weeks*

Sofosbuvir 400 mg, orally, daily

+

Ledipasvir 90 mg, orally, daily

1

12 weeks

Sofosbuvir 400 mg, orally, daily

+

Daclatasvir 60 mg, orally, daily

1, 3

12 weeks (Gt 1)

24 weeks (Gt 3)

PBS = Pharmaceutical Benefits Scheme.

* Sofosbuvir + velpatasvir + voxilaprevir is not yet PBS-listed for the treatment of genotype 1–6 HCV in people in whom direct-acting antiviral therapy has previously failed.