Hepatitis C Virus Treatment Guidelines HEPATITIS C VIRUS TREATMENT GUIDELINES
HEPATITIS C VIRUS TREATMENT GUIDELINES
Treatment naive Peg-IFN/ribavirin treatment experienced
Without cirrhosis With compensated cirrhosis Without cirrhosis With compensated cirrhosis
GENOTYPE 1A
Recommended

• Zepatier for 12wks1 OR

• Mavyret for 8wks OR

• Harvoni for 12wks2 OR

• Epclusa for 12wks

• Zepatier for 12wks1 OR

• Mavyret for 8wks5 OR

• Harvoni for 12wks OR

• Epclusa for 12wks

• Zepatier for 12wks1 OR

• Mavyret for 8wks OR

• Harvoni for 12wks OR

• Epclusa for 12wks

• Zepatier for 12wks1 OR

• Epclusa for 12wks OR

• Mavyret for 12wks

Alternative

 

 

 

 

 

• Harvoni + ribavirin for 12wks

GENOTYPE 1B
Recommended

• Zepatier for 12wks6 OR

• Mavyret for 8wks OR

• Harvoni for 12wks2 OR

• Epclusa for 12wks

• Zepatier for 12wks OR

• Mavyret for 8wks5 OR

• Harvoni for 12wks OR

• Epclusa for 12wks

• Zepatier for 12wks OR

• Mavyret for 8wks OR

• Harvoni for 12wks OR

• Epclusa for 12wks

• Zepatier for 12wks OR

• Epclusa for 12wks OR

• Mavyret for 12wks

Alternative

 

 

 

 

 

• Harvoni + ribavirin for 12wks

GENOTYPE 2
Recommended

• Mavyret for 8wks OR

• Epclusa for 12wks

• Epclusa for 12wks OR

• Mavyret for 8wks5

• Mavyret for 8wks OR

• Epclusa for 12wks

• Epclusa for 12wks OR

• Mavyret for 12wks

GENOTYPE 3
Recommended

• Mavyret for 8wks OR

• Epclusa for 12wks

• Mavyret for 8wks5 OR

• Epclusa for 12wks3

• Epclusa for 12wks3

• Mavyret for 16wks OR

• Vosevi for 12wks

Alternative

 

• Epclusa + ribavirin for 12wks3

• Vosevi for 12wks3

• Mavyret for 16wks OR

• Vosevi for 12wks3

• Zepatier + Sovaldi for 12wks

• Epclusa + ribavirin for 12wks

GENOTYPE 4
Recommended

• Mavyret for 8wks OR

• Epclusa for 12wks OR

• Zepatier for 12wks OR

• Harvoni for 12wks7

• Epclusa for 12wks OR

• Mavyret for 8wks5 OR

• Zepatier for 12wks OR

• Harvoni for 12wks

• Epclusa for 12wks OR

• Mavyret for 8wks OR

• Zepatier for 12wks4 OR

• Harvoni for 12wks

• Epclusa for 12wks OR

• Zepatier for 12wks4 OR

• Mavyret for 12wks

Alternative
   

 

 

• Harvoni + ribavirin for 12wks

GENOTYPE 5, 6
Recommended

• Mavyret for 8wks5 OR

• Epclusa for 12wks OR

• Harvoni for 12wks8

• Mavyret for 8wks5 OR

• Epclusa for 12wks OR

• Harvoni for 12wks8

• Mavyret for 8wks OR

• Harvoni for 12wks OR

• Epclusa for 12wks

• Mavyret for 12wks OR

• Harvoni for 12wks OR

• Epclusa for 12wks

 
PHARMACOLOGICAL THERAPIES
Generic Brand Strength Form Dosage
elbasvir/​grazoprevir Zepatier 50mg/100mg tabs ≥18yrs: 1 tab once daily
glecaprevir/​pibrentasvir Mavyret 100mg/​40mg tabs ≥12yrs or ≥45kg: 3 tabs once daily with food
ledipasvir/​sofosbuvir Harvoni 45mg/​200mg, 90mg/​400mg tabs ≥3yrs (<17kg): 33.75mg/150mg (pellets) once daily; (17–<35kg): 45mg/200mg (tabs or pellets) once daily; (≥35kg): 90mg/400mg (tabs or pellets) once daily. ≥18yrs: 90mg/400mg (tabs) once daily.
Harvoni Oral Pellets 33.75mg/​150mg, 45mg/​200mg pellets
ribavirin 200mg, 400mg, 500mg, 600mg tabs Take with food in 2 divided doses. ≥5yrs (23–33kg): 400mg/day; (34–46kg): 600mg/day; (47–59kg): 800mg/day; (60–74kg): 1g/day; (≥75kg): 1.2g/day. ≥18yrs (<75kg): 1g/day; (≥75kg): 1.2g/day.
sofosbuvir Sovaldi 200mg, 400mg tabs ≥3yrs (<17kg): 150mg (pellets) once daily; (17–<35kg): 200mg (tabs or pellets) once daily; (≥35kg): 400mg (tabs or pellets) once daily. ≥18yrs 400mg (tabs) once daily.
Sovaldi Oral Pellets 150mg, 200mg pellets
sofosbuvir/​velpatasvir Epclusa 200mg/​50mg, 400mg/​100mg tabs ≥6yrs (17–<30kg): 200mg/50mg once daily; (≥30kg): 400mg/100mg once daily. ≥18yrs: 400mg/100mg once daily.
sofosbuvir/​velpatasvir/​voxilaprevir Vosevi 400mg/​100mg/​100mg tabs ≥18yrs: 1 tab once daily with food
NOTES

For recommended and alternative regimens for specific patient populations (eg, treatment-experienced patients previously treated with regimens other than PEG-IFN/ribavirin, decompensated cirrhosis, HIV/HCV co-infection, renal impairment, etc), refer to the full guideline or drug manufacturer’s labeling.

 

1 Patients with no baseline NS5A RASs for elbasvir detected. Includes G1a substitutions at amino acid positions 28, 30, 31, or 93 known to confer antiviral resistance.

2 An 8-week duration is recommended for treatment-naïve patients without cirrhosis who are HIV uninfected, and whose HCV RNA level is <6 million IU/ml.

3 Baseline NS5A RAS Y93H testing for velpatasvir is recommended. If present, ribavirin should be added to the regimen, or change regimen to Vosevi.

4 12 weeks is recommended for patients who experience virologic relapse after PEG-IFN/ribavirin therapy. If the type of prior treatment failure (relapse vs breakthrough/nonresponse) is unknown, another recommended regimen should be used.

5 Duration of 12 weeks is recommended for HIV/HCV co-infection.

6 Consider an 8-week regimen in patients with genotype 1b and mild fibrosis.

7 Consider an 8-week regimen in patients with favorable baseline characteristics (eg, no cirrhosis, HCV RNA <6 million IU/mL, absence of genotype 4r.

8 Not recommended for genotype 6e if subtype is known.

REFERENCES

AASLD-IDSA. HCV Guidance: Recommendations for testing, managing, and treating hepatitis C. http://www.hcvguidelines.org. Accessed October 20, 2020.

(Rev. 10/2020)