口服直接作用抗病毒药物（DAA）极大地改变了治愈HCV（丙型肝炎病毒）感染的可能性，两种主要的HCV方案基于glecaprevir+pibrentasvir(GLE-PIB)和sofosbuvir+velpatasvir(SOF-VEL)的组合。含有NS3/4A蛋白酶抑制剂的药物组合，以及目前几乎所有HCV患者都可以接受治疗的事实，可能会使患者暴露于更高的药物-药物相互作用（DDI）。来自EASL（欧洲肝脏研究协会）的丙型肝炎治疗建议指出，在开始DAA治疗之前，应该详细的用药史；然而，管理潜在DDI的决定并不总是明确的。出于这个原因,一组意大利心脏病学家和肝病学家在同事中进行了一项调查，以评估在治疗慢性丙型肝炎患者同时服用心血管药物时存在的争议问题，旨在就治疗正在服用心血管疾病合并药物的慢性丙型肝炎患者的最佳实践达成共识。在2022年6月至7月之间，向由14名胃肠病学家组成的定性专家小组（EP）提出了两个连续的问卷，感染学家，肝病学家,和内科医生，对两份问卷的100%回复进行统计分析。专家之间的协议是按照兰德公司开发的德尔菲法进行评估的。受访专家认为DDI是HCV患者需要评估的关键临床问题。因此,剂量变化,药物替代，并且应劝阻停用伴随的心血管药物，即使计划时间相对较短。由于口头DAA具有不同的DDI配置文件，肝病学家应该更喜欢呈现潜在相互作用的最低实例的抗病毒DAA组合。
Orally administered direct-acting antivirals (DAAs) have dramatically changed the possibility of curing HCV (hepatitis C virus) infection, with the two principal HCV regimens based on the combination of glecaprevir + pibrentasvir (GLE-PIB) and sofosbuvir + velpatasvir (SOF-VEL). A combination of drugs containing NS3/4A protease inhibitors, as well as the fact that almost all HCV patients can be treated at present, may expose patients to a higher rate of drug-drug interactions (DDIs). The hepatitis C treatment recommendations from the EASL (European Association for the Study of the Liver) state that, prior to starting treatment with a DAA, a detailed drug history should be taken; yet, the decision on managing the potential DDIs is not always clear. For this reason, a group of Italian cardiologists and hepatologists promoted a survey among colleagues to assess the controversial issues when treating patients with chronic hepatitis C taking concomitant cardiovascular drugs, aiming to reach a
consensus on the best practice to apply when treating a patient with chronic hepatitis C who is taking concomitant drugs for cardiovascular diseases. Two consecutive questionnaires were proposed between June and July 2022 to a qualitative Expert Panel (EP) of 14 gastroenterologists, infectologists, hepatologists, and internists, with statistical analyses performed on 100% of the responses for both questionnaires. Agreement among experts was assessed following the Delphi method as developed by the RAND Corporation. The interviewed experts consider DDIs a critical clinical problem to be evaluated in HCV patients. Therefore, dose changes, drug substitution, and discontinuation of concomitant cardiovascular drugs should be discouraged, even if planned for a relatively short period. Since oral DAAs have different DDIs profiles, hepatologists should prefer the antiviral DAA combination presenting the lowest instance of potential interactions.
