Pan-genotypic regimens for chronic infection with genotypes 1–6 HCV
Sofosbuvir plus velpatasvir
The first pan-genotypic regimen for the treatment of HCV genotypes 1–6 HCV is the combination of sofosbuvir plus velpatasvir.31,32 Sofosbuvir plus velpatasvir is a coformulated, once-daily, single-pill regimen. The recommended treatment duration is 12 weeks for all people. Rates of SVR ³ 95% were reported in clinical trials. Patients with Gt 3 HCV who have cirrhosis and/or in whom peginterferon plus ribavirin has previously failed have been observed to have slightly lower rates of SVR (89%–93%).32 For this group, consider adding ribavirin to the treatment regimen (Table 3). Patients with decompensated liver disease should also be treated with sofosbuvir plus velpatasvir plus ribavirin (see Section 8).
The most common adverse events in clinical trials were headache, fatigue, nausea and nasopharyngitis; rates were not significantly different compared with placebo.31,32 Sofosbuvir and its main metabolite GS-331007 are renally excreted. As safety data are lacking in people with an estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73m2, sofosbuvir is not recommended in this setting (see Section on People with severe renal impairment). The combination of sofosbuvir plus velpatasvir is safe and well tolerated even in people with decompensated cirrhosis (see section on Special Populations: treatment of decompensated liver disease).