Table 2.

Adverse Effects of HCV Therapy in the DAA Era

Adverse effect	Related medications	Treatment and management	Comments
Flu-like symptoms	Interferon Ribavirin	Regular daily schedule Adequate sleep Hydration Exercise Acetaminophen	May include fatigue, myalgias, weakness,  fever, and insomnia.
Anemia	Interferon Ribavirin Telaprevir Boceprevir Faldaprevir	Ribavirin dose reduction Erythropoietin or other  erythrocyte-stimulating agents Blood transfusions	DAA association with anemia is greatest for  boceprevir, telaprevir, and faldaprevir.
Neutropenia	Interferon Ribavirin	Interferon dose reduction Filgrastim	Unclear clinical significance of neutropenia  due to lack of association with infection.
Rash	Telaprevir Boceprevir Simeprevir Faldaprevir	Preventative skin care and hydration Topical corticosteroids Topical anti-histamine Oral anti-histamines DAA withdrawal	Severe rash (>50 % of body surface area or  systemic symptoms) requires DAA  withdrawal and progression warrants  discontinuation of all medications.
Anorectal discomfort	Telaprevir	Diet modification (increased fat intake) Barrier creams Sitz baths Topical corticosteroids Topical lidocaine	Diarrhea may require additional workup and  evaluation.
Dysgeusia	Boceprevir	Hydration Candies or lozenges Using plastic utensils
Depression	Interferon	Patient selection Support groups and services Anti-depressants	Monitoring for suicidality is essential while  on interferon based therapies for at-risk  patients.

DAA Direct acting antiviral