American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the primary indication for the combination of sofosbuvir and simeprevir?

1. Treatment of HCV genotype in all patients

2. Management of drug-resistant infections

3. Treatment of HCV genotype 1 in interferon-ineligible patients

4. Relief of symptoms in patients with liver failures

The correct answer is: Treatment of HCV genotype 1 in interferon-ineligible patients

The primary indication for the combination of sofosbuvir and simeprevir is the treatment of HCV genotype 1 in patients who are not eligible for interferon therapy. This combination therapy is particularly effective because sofosbuvir is a direct-acting antiviral agent that targets the NS5B polymerase, which is essential for the replication of the hepatitis C virus. Simeprevir, on the other hand, is an NS3/4A protease inhibitor that complements the action of sofosbuvir by inhibiting another critical step in the viral lifecycle. Patients who are interferon-ineligible may have various reasons for this designation, including contraindications due to underlying health conditions, adverse effects, or other factors such as a poor performance status. The combination treatment allows these patients to receive effective antiviral therapy with a high cure rate, thus significantly improving their liver health outcomes. In contrast, while the treatment of HCV genotype should encompass all genotypes, the use of this specific combination is particularly focused on genotype 1 and is not a blanket indication for all patients with varying genotypes. The management of drug-resistant infections typically relates to bacterial infections rather than viral hepatitis treatment. Additionally, relief of symptoms in patients with liver failure does not specifically address