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. Topics covered Hepatitis C as a curable disease and the drug classes The reflex antibody-then-RNA diagnostic algorithm Universal screening and the pre-treatment workup The two pangenotypic regimens and the salvage regimen Sustained virologic response and what cure buys Decompensated cirrhosis and the protease-inhibitor rule Kidney disease, transplant, and pregnancy Post-cure cancer surveillance by fibrosis stage Key decisions Diagnose 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. A 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. The 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. Sustained virologic response means undetectable RNA twelve weeks after the end of treatment, not twelve weeks of treatment, and that is the trap. Protease 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. Advanced kidney disease no longer forbids sofosbuvir, but glecaprevir-pibrentasvir is the simplest choice in renal impairment or dialysis when liver function is preserved. Post-cure cancer surveillance continues every six months indefinitely in patients who had F4 cirrhosis at cure, while patients with F3 fibrosis short of cirrhosis stop surveillance after clearance. For the full chapter with MCQs, tables, and primary-guideline references, visit www.boardpearls.com. Questions or feedback: [email protected]. (00:00) - Introduction: hepatitis C is curable (00:27) - The cure framework and drug classes (01:33) - The reflex antibody-then-RNA diagnosis (03:41) - Screening and the pre-treatment workup (04:30) - The two pangenotypic regimens and salvage (06:36) - Sustained virologic response and what cure buys (08:03) - Special populations and decompensated cirrhosis (09:51) - Kidney disease, transplant, and pregnancy (12:20) - Post-cure cancer surveillance by fibrosis stage

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“What did the council decide on item 42?” — answered with the speaker and the moment.

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