**10. Conclusion**

**d.** Daily fixed-dose combination of paritaprevir (150 mg)/ritonavir (100 mg)/ombitasvir (25 mg) plus twice-daily dosed dasabuvir (250 mg) and weight-based ribavirin (1000 mg [<75 kg] to 1200 mg [>75 mg]), in the allograft, without cirrhosis, for 24 weeks in patients with

**e.** Daily sofosbuvir (400 mg) plus daclatasvir (60 mg) with or without weight-based ribavirin (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 24 weeks for patients with HCV genotypes 1, 3, 4, 5, and 6 in the allograft, including those with compensated and decompensated cirrhosis is another combination with high virological response and improvement of liver

**f.** Daily sofosbuvir (400 mg) and weight-based ribavirin (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 24 weeks is recommended for patients with HCV genotype 2 in the allograft,

**g.** Daily sofosbuvir (400 mg) and weight-based ribavirin (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 24 weeks is recommended as alternative for treatment patients with HCV genotype 3 infection in the allograft, including compensated and decompensated cirrho‐

For patients with creatinine clearance of >30 mL/min, no dosage adjustment is required when using simeprevir, sofosbuvir, daclatasvir, fixed-dose combination of ledipasvir (90 mg)/ sofosbuvir (400 mg), or fixed-dose combination of paritaprevir (150 mg)/ritonavir (100 mg)/ ombitasvir (25 mg) plus twice-daily dosed dasabuvir (250 mg) to treat patients with HCV infection. Simeprevir, daclatasvir, and the combination of paritaprevir, ritonavir, ombitasvir and dasabuvir are cleared by hepatic metabolism and can be used in patients with severe renal

EASL Recommendations on Treatment of Hepatitis C 2015 and AASLD/IDSA/IAS-USA 2014 guidelines on HCV treatment do not recommend sofosbuvir in patients with creatinine

When the efficacy of the treatment of acute HCV infection was superior to the treatment of chronic infection, there was a strong impetus to identify and treat acute HCV infection with interferon [106]. The current availability of interferon-sparing HCV treatments that have high safety and efficacy reduces the advantage of early treatment of HCV infection. Until data documenting the efficacy and safety of treatment of acute hepatitis C with direct acting antiviral drugs are available, monitoring for spontaneous clearance for minimum of 6 months before initiating treatment is required. When a decision is made to treat patients after 6 months

of acute infection, then the patient can be treated as described for chronic HCV [93].

clearance of <30 mL/min or with ESRD until more data are available [91,93].

HCV genotype 1 infection.

96 Recent Advances in Liver Diseases and Surgery

including compensated cirrhosis.

**9.4. Patients with renal impairments**

**9.5. Patients with acute HCV infection**

function.

sis.

impairment [91].

Chronic hepatitis C in the presence of the new direct-acting antiviral drugs became a curable disease, with a sustained virological response of more than 90%. The second-generation protease inhibitors that have been approved for treatment of HCV and are available in the market are simeprevir, sofosbuvir, ledipasvir/sofosbuvir, daclatasvir, and the combination of ombitasvir-paritaprevir-ritonavir and dasabuvir. The cost of these new agents prevents universal delivery of medications and prioritization of treatment should be given to patients who are in need of immediate care like those with advanced liver disease and extrahepatic complications. Trials are still ongoing with other new products, many of which are expected to appear in the market soon.
