A 52-year-old man with HCV genotype 1b infection and compensated cirrhosis (Child-Pugh A) is being evaluated for direct-acting antiviral (DAA) therapy. Which DAA regimen is appropriate and what is the expected sustained virological response (SVR) rate?
- A Glecaprevir/pibrentasvir (Mavyret) for 8-12 weeks; SVR >97% ✓
- B Sofosbuvir + ribavirin for 24 weeks; SVR ~50%
- C Pegylated interferon + ribavirin for 48 weeks; SVR ~40%
- D Sofosbuvir + simeprevir for 12 weeks; SVR ~55% in genotype 1b
Correct answer: A. Glecaprevir/pibrentasvir (Mavyret) for 8-12 weeks; SVR >97%
Explanation
Pangenotypic DAA regimens — glecaprevir/pibrentasvir (NS3/4A + NS5A inhibitors) and sofosbuvir/velpatasvir — achieve SVR rates >97% across all HCV genotypes, including genotype 1b. For compensated cirrhosis (Child-Pugh A), glecaprevir/pibrentasvir is given for 12 weeks (8 weeks for non-cirrhotics, treatment-naive). Older interferon-based regimens are obsolete. Sofosbuvir+simeprevir was used before pangenotypic DAAs with lower SVR rates. SVR is considered a virological cure and reduces hepatic decompensation, HCC risk, and all-cause mortality.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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