Rational Approach Toward COVID-19 Main Protease Inhibitors Via Molecular Docking, Molecular Dynamics Simulation and Free Energy
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Faldaprevir, Pegylated Interferon, and Ribavirin for Treatment-Naïve HCV Genotype-1: Pooled Analysis of Two Phase 3 Trials
Faldaprevir, pegylated interferon and ribavirin. , 2016; 15 (3): 333-349 333 ORIGINAL ARTICLE May-June, Vol. 15 No. 3, 2016: 333-349 The Official Journal of the Mexican Association of Hepatology, the Latin-American Association for Study of the Liver and the Canadian Association for the Study of the Liver Faldaprevir, pegylated interferon, and ribavirin for treatment-naïve HCV genotype-1: pooled analysis of two phase 3 trials Donald M. Jensen,1 Tarik Asselah,2 Douglas Dieterich,3 Graham R. Foster,4 Mark S. Sulkowski,5 Stefan Zeuzem,6 Parvez Mantry,7 Eric M. Yoshida,8 Christophe Moreno,9 Denis Ouzan,10 Mark Wright,11 Luis E. Morano,12 Robert Buynak,13 Marc Bourlière,14 Tarek Hassanein,15 Shuhei Nishiguchi,16 Jia-Horng Kao,17 Masao Omata,18 Seung W. Paik,19 David K. Wong,20 Edward Tam,21 Kelly Kaita,22 S. Victor Feinman,23 Jerry O. Stern,24 Joseph Scherer,24 Anne-Marie Quinson,24 Florian Voss,25 John-Paul Gallivan,25 Wulf O. Böcher,25 Peter Ferenci26 1 University of Chicago Medicine, Chicago, IL, USA. 2 Hôpital Beaujon, APHP, University Paris-Diderot and INSERM CRB3, Clichy, France. 3 Icahn School of Medicine at Mount Sinai, New York, NY, USA. 4 Queen Mary University of London, London, UK. 5 Johns Hopkins University School of Medicine, Baltimore, MD, USA. 6 J.W.Goethe University Hospital, Frankfurt, Germany. 7 The Liver Institute at Methodist Dallas Medical Center, Dallas, TX, USA. 8 University of British Columbia, Vancouver, BC, Canada. 9 CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium. 10 Institut Arnault Tzanck, St. -
Faldaprevir Combined with Peginterferon Alfa2a and Ribavirin In
Faldaprevir Combined With Peginterferon Alfa-2a and Ribavirin in Chronic Hepatitis C Virus Genotype-1 Patients With Prior Nonresponse: SILEN-C2 Trial Mark S. Sulkowski,1 Marc Bourlie`re,2 Jean-Pierre Bronowicki,3 Tarik Asselah,4 Jean-Michel Pawlotsky,5 Stephen D. Shafran,6 Stanislas Pol,7 Stefan Mauss,8 Dominique Larrey,9 Yakov Datsenko,10 Jerry O. Stern,11 George Kukolj,12 Joseph Scherer,11 Gerhard Nehmiz,10 Gerhard G. Steinmann,10 and Wulf O. B€ocher13 Faldaprevir (BI 201335) is a potent, hepatitis C virus (HCV) NS3/4A protease inhibitor. In all, 290 noncirrhotic HCV genotype (GT)-1 patients with prior null (<1log10 viral load [VL] drop at any time on treatment) or partial response (1log10 VL drop but never undetectable on treatment) were randomized 2:1:1 to receive 48 weeks of peginterferon alfa-2a and ribavirin (PegIFN/RBV) in combination with faldaprevir 240 mg once daily (QD) with 3 days PegIFN/RBV lead-in (LI), 240 mg QD without LI, or 240 mg twice daily (BID) with LI. Patients in the 240 mg QD/LI group achieving maintained rapid virologic response (mRVR; VL <25 IU/mL [Roche TaqMan] at week 4 and undetectable at weeks 8 to 20) were rerandomized to cease all treatment at week 24 or continue PegIFN/RBV up to week 48. Sustained virologic response (SVR) rates were 32%, 50%, and 42% in prior partial responders, and 21%, 35%, and 29% in prior null responders in the faldaprevir 240 mg QD/LI, 240 mg QD, and 240 mg BID/LI groups, respectively. -
Startverso4 PHASE III TRIAL of FALDAPREVIR PLUS PEGYLATED INTERFERON Α-2A and RIBAVIRIN in PATIENTS with HIV and HCV GENOTYPE-1 CO-INFECTION
STARTVerso4 PHASE III TRIAL OF FALDAPREVIR PLUS PEGYLATED INTERFERON α-2a AND RIBAVIRIN IN PATIENTS WITH HIV AND HCV GENOTYPE-1 CO-INFECTION JK Rockstroh1, M Nelson2, V Soriano3, K Arastéh4, J Guardiola5, S Bhagani6, J Mallolas7, C Tural8, M Puoti9, P Ingiliz10, M Battegay11, MK Jain12, M Núñez13, K Marks14, J Kort15, JO Stern15, R Vinisko15, M Manero16, D Dieterich17, on behalf of the STARTVerso4 Study Group 1University of Bonn, Bonn, Germany; 2Chelsea and Westminster Hospital, London, UK; 3Hospital Carlos III, Madrid, Spain; 4EPIMED, Vivantes Auguste-Viktoria Hospital, Berlin, Germany; 5Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; 6Royal Free Hospital, London, UK; 7Hospital Clínic, Barcelona, Spain; Jürgen K. Rockstroh 1099 8Hospital Universitari Germans Trias i Pujol, Barcelona, Spain; 9AO Ospedale Niguarda Cà Granda, Milan, Italy; 10Medizinisches Infektiologiezentrum Berlin (MIB), Berlin, Germany; 11Division of Infectious Diseases and Hospital Epidemiology, Basel, Switzerland; 12UT Southwestern Medical Center, Dallas, TX, USA; 13Wake Forest University, Winston-Salem, NC, USA; 14Weill Cornell Medical College, New York, NY, USA; 15Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA; 16Boehringer Ingelheim España S.A., Barcelona, Spain; 17Mount Sinai School of Medicine, New York, NY, USA [email protected] BACKGROUND RESULTS EFFICACY FIGURE 4e. SVR4 by ART (total population) TABLE 5. AE summary ●● SVR4 was achieved by 74% of patients overall (Figure 3). FDV 120 mg FDV 240 mg + PR + PR Total ●● Faldaprevir (FDV) is a potent inhibitor of HCV NS3/4A.1 PATIENTS - SVR4 rates were comparable across FDV doses and durations of treatment. 24 weeks Total FDV + PR a ●● 1 n (%) (N=123) (N=185) (N=308) FDV has antiviral activity against HCV genotypes (GT) 1, 4, 5, and 6 in vitro. -
Design and Synthesis of Hepatitis C Virus NS3 Protease Inhibitors
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Pharmacy 197 Design and Synthesis of Hepatitis C Virus NS3 Protease Inhibitors Targeting Different Genotypes and Drug-Resistant Variants ANNA KARIN BELFRAGE ACTA UNIVERSITATIS UPSALIENSIS ISSN 1651-6192 ISBN 978-91-554-9166-6 UPPSALA urn:nbn:se:uu:diva-243317 2015 Dissertation presented at Uppsala University to be publicly examined in B41 BMC, Husargatan 3, Uppsala, Friday, 27 March 2015 at 09:15 for the degree of Doctor of Philosophy (Faculty of Pharmacy). The examination will be conducted in Swedish. Faculty examiner: Ulf Ellervik (Lunds tekniska högskola). Abstract Belfrage, A. K. 2015. Design and Synthesis of Hepatitis C Virus NS3 Protease Inhibitors. Targeting Different Genotypes and Drug-Resistant Variants. Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Pharmacy 197. 108 pp. Uppsala: Acta Universitatis Upsaliensis. ISBN 978-91-554-9166-6. Since the first approved hepatitis C virus (HCV) NS3 protease inhibitors in 2011, numerous direct acting antivirals (DAAs) have reached late stages of clinical trials. Today, several combination therapies, based on different DAAs, with or without the need of pegylated interferon-α injection, are available for chronic HCV infections. The chemical foundation of the approved and late-stage HCV NS3 protease inhibitors is markedly similar. This could partly explain the cross-resistance that have emerged under the pressure of NS3 protease inhibitors. The first-generation NS3 protease inhibitors were developed to efficiently inhibit genotype 1 of the virus and were less potent against other genotypes. The main focus in this thesis was to design and synthesize a new class of 2(1H)-pyrazinone based HCV NS3 protease inhibitors, structurally dissimilar to the inhibitors evaluated in clinical trials or approved, potentially with a unique resistance profile and with a broad genotypic coverage. -
Incidence and Predictors of Hepatocellular Carcinoma In
Massimo Puoti Dept. of Infectious Diseases AO Ospedale Niguarda Cà Granda Milan, Italy The revolving alphabet soup of hepatitis viral infections Hepatitis C drug therapy – present© by and author future ESCMID Online Lecture Library Hepatitis C drug therapy • The present • The future © by author ESCMID Online Lecture Library Anti HCV agents Interferon and Ribavirin © by author ESCMID Online Lecture Library Viral Load vs. Time 1.E+08 • Lack of sensitivity to IFN 1.E+07 • Insufficient antiviral activity 1st phase 1.E+06 2nd phase • Defective clearance of DNA (cp/ml) DNA - 1.E+05 3rd phase infected cells HBV 1.E+04 4th phase 1.E+03 -7 7 21 35 ©49 by63 author77 91 105 119 133 147 161 175 Time (days) • In theESCMID first 2-3 weeks of therapy, Online the viral load Lecturedecline derives mainly Library from the reduction of viral production direct antiviral effect of the drug • Thereafter the viremia decline derives mainly from the clearance of infected cell Colombatto P et al.. Antiv Ther, 2003 Patterns of Virologic Response 7 Null response [1] 6 5 IU/mL) 10 4 Partial response 3 Relapse 40% chance 2 of SVR with © by author pegIFN/RBV[2] HCV RNA (log HCV RNA 1 Undetectable RVR EVR EOT SVR 0 ESCMID-8 -4 -2 0 4Online 8 12 16 Lecture20 24 32 40 48Library 52 60 72 Wks After Start of Therapy 1. Ghany MG, et al. Hepatology. 2009;49:1335-1374. 2. McHutchison JG, et al. N Engl J Med. 2009;361:580-593. WHAT WE HAVE LEARNED ABOUT TREATMENT (IFN) FAILURE Response to IFN alfa depends on : . -
HCV Eradication with Direct Acting Antivirals (Daas)?
HCV eradication with direct acting antivirals (DAAs)? Emilie Estrabaud Service d’Hépatologie et INSERM UMR1149, AP-HP Hôpital Beaujon, Paris, France. [email protected] HCV eradication with direct acting antivirals (DAAs)? HCV replication HCV genome and DAAs targets NS3 inhibitors NS5A inhibitors NS5B inhibitors Take home messages HCV viral cycle Asselah et al. Liver Int. 2015;35 S1:56-64. Direct acting antivirals 5’NTR Structural proteins Nonstructural proteins 3’NTR Metalloprotease Envelope Serine protease Glycoproteins RNA Capsid RNA helicase Cofactors Polymerase C E1 E2 NS1 NS2 NS3 NS4A NS4B NS5A NS5B Protease Inhibitors NS5A Inhibitors Polymerase Inhibitors Telaprevir Daclatasvir Nucs Non-Nucs Boceprevir Ledipasvir Simeprevir ABT-267 Sofosbuvir ABT-333 Faldaprevir GS-5816 VX-135 Deleobuvir Asunaprevir Direct Acting Antivirals: 2015 Asselah et al. Liver Int. 2015;35 S1:56-64. Genetic barrier for HCV direct acting antivirals High Nucleos(t)ide 1 mutation= high cost to Analog Inhibitors fitness, 2-3 additional mutations to increase fitness 2 st generation Protease Inhibitors n Non Nucleos(t)ide Analog Inhibitors : NS5 A Inhibitors 1 st generation Protease Inhibitors 1 mutation= low cost to fitness Low Halfon et al. J Hepatol 2011. Vol 55(1):192-206. HCV protease inhibitors (PI) Inhibit NS3/NS4A serine protease responsible for the processing of the polyprotein 1st generation 1st generation, 2nd wave 2nd generation Resistance low low high barrier Genotype activity 1: 1 a< 1b All except 3 all Drug drug Important Less Less interaction Drugs Boceprevir Simeprevir (Janssen) MK-5172 Telaprevir Faldaprevir (BI) ACH-2684 Paritaprevir (ABT-450)/r (AbbVie) Vedroprevir (Gilead) Vaniprevir (Merck) Sovaprevir (Achillion) Asunaprevir (BMS) NS3/NS4A structure Repositioning of helicase domain Self cleavage Lipid Bilayer Inactive Insertion of the Active carboxy-terminal tail Bartenschlager et al. -
Caracterización Molecular Del Perfil De Resistencias Del Virus De La
ADVERTIMENT. Lʼaccés als continguts dʼaquesta tesi queda condicionat a lʼacceptació de les condicions dʼús establertes per la següent llicència Creative Commons: http://cat.creativecommons.org/?page_id=184 ADVERTENCIA. El acceso a los contenidos de esta tesis queda condicionado a la aceptación de las condiciones de uso establecidas por la siguiente licencia Creative Commons: http://es.creativecommons.org/blog/licencias/ WARNING. The access to the contents of this doctoral thesis it is limited to the acceptance of the use conditions set by the following Creative Commons license: https://creativecommons.org/licenses/?lang=en Programa de doctorado en Medicina Departamento de Medicina Facultad de Medicina Universidad Autónoma de Barcelona TESIS DOCTORAL Caracterización molecular del perfil de resistencias del virus de la hepatitis C después del fallo terapéutico a antivirales de acción directa mediante secuenciación masiva Tesis para optar al grado de doctor de Qian Chen Directores de la Tesis Dr. Josep Quer Sivila Dra. Celia Perales Viejo Dr. Josep Gregori i Font Laboratorio de Enfermedades Hepáticas - Hepatitis Víricas Vall d’Hebron Institut de Recerca (VHIR) Barcelona, 2018 ABREVIACIONES Abreviaciones ADN: Ácido desoxirribonucleico AK: Adenosina quinasa ALT: Alanina aminotransferasa ARN: Ácido ribonucleico ASV: Asunaprevir BOC: Boceprevir CCD: Charge Coupled Device CLDN1: Claudina-1 CHC: Carcinoma hepatocelular DAA: Antiviral de acción directa DC-SIGN: Dendritic cell-specific ICAM-3 grabbing non-integrin DCV: Daclatasvir DSV: Dasabuvir -
Response-Guided Therapy in Patients with Genotype 1 Hepatitis C Virus: Current Status and Future Prospects Eric J Lawitz and Fernando E Membreno
bs_bs_banner doi:10.1111/jgh.12632 REVIEW Response-guided therapy in patients with genotype 1 hepatitis C virus: Current status and future prospects Eric J Lawitz and Fernando E Membreno The Texas Liver Institute, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA Key words Abstract direct-acting antiviral, HCV RNA, protease inhibitors, response-guided therapy. On-treatment responses to antiviral therapy are used to determine duration of therapy in patients being treated for genotype 1 hepatitis C virus infection. Such use of response- Accepted for publication 9 March 2014. guided therapy has successfully reduced exposure of patients to the side-effects of pegylated interferon and ribavirin without jeopardizing overall treatment success. Correspondence Response-guided therapy is an integral part of treatment using the current standard treat- Dr Eric J Lawitz, 607 Camden Street, ments involving the direct-acting antiviral (DAA) agents—boceprevir or telaprevir— University of Texas Health Science Center, combined with pegylated interferon/ribavirin. Improvements in our understanding of the San Antonio, TX 78215, USA. kinetics of viral load during antiviral therapy have shown us that more potent suppression Email: [email protected] of viral replication increases the rate of viral eradication, providing impetus for the development of more potent DAAs. Emerging results from clinical trials of these agents— including trials of interferon-free DAA combinations—suggest that very high rates of viral eradication are achievable, even in patients who failed to respond to previous courses of interferon-based therapy. Furthermore, because of these high rates of treatment success, on-treatment assessment of viral response may become unnecessary. -
Appendices: V Ervolgonderzoek Medicatieveiligheid
APPENDICES: V ERVOLGONDERZOEK MEDICATIEVEILIGHEID Dit is een bijlage bij het rapport Vervolgonderzoek Medicatieveiligheid en is opgesteld voor het Ministerie van VWS vanuit een samenwerkingsverband tussen het Erasmus MC (Rotterdam), NIVEL (Utrecht), Radboud UMC (Nijmegen) en PHARMO (Utrecht) Januari 2017 Versie 1.0 1 Appendices Hoofstuk 2: Onderzoek naar de mate van opvolging van HARM-Wrestling aanbevelingen (2009-2014) 2 Appendix 1 Appendix 1: Technische omzetting van HARM-Wrestling aanbevelingen naar indicatoren Algemene specificaties Tabel A1a. Bepaling van medicatiegebruik. Geneesmiddel of ATC-code geneesmiddelen groep Antidepressiva N06A Laag gedoseerd ASA B01AC06, B01AC08, B01AC30, N02BA15 (dosering 100mg) of N02BA01 (dosering 80mg) Benzodiazepinen N05CF, N05CD, N05BA of N05CC Beta-blokkers C07 Bisfosfonaten M05BA, M05BB, of M05XX Calcineurine remmers L04AA05 of L04AD01 Carbamazepine N03AF01 Corticosteroiden H02AB Co-trimoxazol J01EE01 Coxibs M01AH Diabetesmedicatie A10 Digoxine C01AA05 Glibenclamide A10BB01 of A10BD02 of A10BD04 H2RA A02BA Itraconazol J02AC02 Kaliumsparende diuretica C03DA, C03DB, of C03EA Kaliumverliezende diuretica C03A, C03B, C03E, C07B, C07CB03, C09BA, C09DA, C09XA52, C03C of C09DX01 Ketoconazol J02AB02 Niet-selectieve NSAID’s N02BA01, N02BA15, N02BA11, N02BA51, N02BA65 of M01A met uitzondering van M01AH, M01AX05, M01AX12, M01AX21, M01AX24, M01AX25 en M01AX26 Laxantia A06A, A02AA02, A02AA03, A02AA04, A06AC, A06AA, of A06AG Lisdiuretica C03C Macroliden J01FA of A02BD04 VKA B01AA Opioïden N02AA met uitzondering van N02AA55, N02AA59 en N02AA79, N02AB, N02AC, N02AD, N02AG, N02AE of N07BC01 Pentamidine P01CX01 PPI’s A02BC of M01AE52 RAS-remmers C09 Sotalol C07AA07 Spironolacton C03DA01 SSRI's N06AB, N06AX21 of N06AX16 Sulonylureumderivaten A10BB, A10BD02 of A10BD04 Thiazidediuretica C03A, C03B, C03EA, C07B, C09BA, C09DA, C09XA52, C09DX01 of C07CB03 TAR B01AC04, B01AC06, B01AC08, B01AC22, B01AC30, N02BA15 (dosering 100mg) of N02BA01 (dosering 80mg) Thienopyridine derivaten B01AC04, B01AC22 of B01AC30 3 Appendix 1 Tabel A1b. -
Surveillance of Antimicrobial Consumption in Europe 2013-2014 SURVEILLANCE REPORT
SURVEILLANCE REPORT SURVEILLANCE REPORT Surveillance of antimicrobial consumption in Europe in Europe consumption of antimicrobial Surveillance Surveillance of antimicrobial consumption in Europe 2013-2014 2012 www.ecdc.europa.eu ECDC SURVEILLANCE REPORT Surveillance of antimicrobial consumption in Europe 2013–2014 This report of the European Centre for Disease Prevention and Control (ECDC) was coordinated by Klaus Weist. Contributing authors Klaus Weist, Arno Muller, Ana Hoxha, Vera Vlahović-Palčevski, Christelle Elias, Dominique Monnet and Ole Heuer. Data analysis: Klaus Weist, Arno Muller and Ana Hoxha. Acknowledgements The authors would like to thank the ESAC-Net Disease Network Coordination Committee members (Marcel Bruch, Philippe Cavalié, Herman Goossens, Jenny Hellman, Susan Hopkins, Stephanie Natsch, Anna Olczak-Pienkowska, Ajay Oza, Arjana Tambić Andrasevic, Peter Zarb) and observers (Jane Robertson, Arno Muller, Mike Sharland, Theo Verheij) for providing valuable comments and scientific advice during the production of the report. All ESAC-Net participants and National Coordinators are acknowledged for providing data and valuable comments on this report. The authors also acknowledge Gaetan Guyodo, Catalin Albu and Anna Renau-Rosell for managing the data and providing technical support to the participating countries. Suggested citation: European Centre for Disease Prevention and Control. Surveillance of antimicrobial consumption in Europe, 2013‒2014. Stockholm: ECDC; 2018. Stockholm, May 2018 ISBN 978-92-9498-187-5 ISSN 2315-0955 -
IFNL4-ΔG Genotype Is Associated with Slower Viral Clearance In
BRIEF REPORT IFNL4-ΔG Genotype Is Associated In treatment-naive hepatitis C virus (HCV) genotype-1 pa- tients, the current standard-of-care treatment, an NS3 prote- With Slower Viral Clearance in ase inhibitor with IFN-α/RBV, results in sustained virological Hepatitis C, Genotype-1 Patients response (SVR) rates of 63%–75% [1]. However, many pa- tients remain untreated due to relative or absolute contraindi- Treated With Sofosbuvir and cations, fear of adverse events, or pill burden. Treatment of Ribavirin chronic HCV infection is evolving towards IFN-α–free, direct-acting antiviral (DAA) regimens that specifically target Eric G. Meissner,1,a Dimitra Bon,2,a Ludmila Prokunina-Olsson,3 the HCV protease (NS3/4A), RNA polymerase (NS5B), or 3 4 ’ 5 2 Wei Tang, Henry Masur, Thomas R. O Brien, Eva Herrmann, nonstructural protein NS5A. While phase 2 and 3 studies of Shyamasundaran Kottilil,1 and Anuoluwapo Osinusi1,6,7 DAA therapies demonstrate promising efficacy and tolerabili- 1Laboratory of Immunoregulation/National Institute of Allergy and Infectious Diseases/National Institutes of Health, Bethesda, Maryland; 2Institute of ty [2], issues of cost and access to treatment will remain rele- Biostatistics and Mathematical Modeling, Johann Wolfgang Goethe University, vant. Identification of host factors that affect differential 3 Frankfurt, Germany; Laboratory of Translational Genomics, Division of Cancer response to DAA therapies could permit personalization of Epidemiology and Genetics/National Cancer Institute/National Institutes of Health, HCV -
Current Treatment of Chronic Hepatitis C
LUIS S. MARSANO, MD, FACG, FAASLD, AGAF, FASGE Professor of Medicine Jewish Hospital Distinguished Chair in Hepatology Division of Gastroenterology, Hepatology and Nutrition University of Louisville and Louisville VAMC October 2020 No conflict of interest to report. Several of the treatment protocols described are not within FDA label but they are inside the “Practice Guidelines Recommendations” from the AASLD and IDSA. Combinations Type of Antiviral Non-Nuc Nuc NS3 NS5A RBV NS5B NS5B “previr” “asvir” “buvir” “buvir” Simeprevir + sofosbuvir Ledipasvir/sofosbuvir FDC (HARVONI) Paritaprevir/r/Ombitasvir FDC (TECHNIVIE or PrO) + Dasabuvir (VIEKIRA Pak and XR or RBV only for 1a PrOD or 3D) or F3-4 Sofosbuvir + ribavirin Daclatasvir + sofosbuvir Grazoprevir + Elbasvir (ZEPATIER) Velpatasvir + Sofosbuvir (EPCLUSA) Sofosbuvir + Velpatasvir + Voxilaprevir (Vosevi®) Glecaprevir + Pibrentasvir (Mavyret) Regimen-SpecificSimplified Recommendations HCV Treatment for Use for of RAS TestingTreatment in Clinical-Naïve Practice Patients Without Cirrhosis ELIGIBLE FOR SIMPLIFIED HCV TREATMENT NOT ELIGIBLE FOR SIMPLIFIED HCV TREATMENT Patients with chronic hepatitis C who do not have cirrhosis and have not previously received Hepatitis C treatment Patients who have any of the following characteristics: • Prior hepatitis C treatment • Cirrhosis • Prior liver transplant PRETREATMENT ASSESSMENT • HIV or HBsAg positive Cirrhosis Assessment Pretreatment Lab Testing • Known or Suspected Hepatocellular Carcinoma • Biopsy not required Within