Regimens for chronic infection Gt 2 HCV
Sofosbuvir plus velpatasvir
The combination of sofosbuvir plus velpatasvir is a safe and effective treatment for Gt 2 HCV (see Section Sofosbuvir and Velpatasvir and Table 4).
The recommended treatment duration is 12 weeks for all patients. Cure rates > 95% were observed in clinical trials, including among people with cirrhosis.31 This is now the recommended regimen for treating patients with Gt 2 HCV.
Sofosbuvir plus ribavirin
The combination of sofosbuvir plus ribavirin for 12 weeks is now considered a second-line regimen for Gt 2 HCV, given concerns about lower efficacy in people with cirrhosis and the potential for ribavirin-related toxicity. Sofosbuvir plus ribavirin was the first IFN-free treatment regimen for Gt 2 HCV available for prescription under the PBS (Table 4). This regimen is highly effective in people with no cirrhosis, with overall cure rates of 90%–95%.49-52 In people with cirrhosis, lower SVR rates have been observed. Treatment extension may increase SVR rates in people with cirrhosis. Evidence for this comes from data for treatment-experienced people with Gt 2 HCV and cirrhosis, in whom treatment extension from 12 to 16 weeks improved SVR rates from 60% to 78%.50 A subsequent study in the same population demonstrated a non-significant trend for higher SVR rates with treatment extension to 24 weeks (16 v 24 weeks: SVR, 87% v 100%).52 Note that treatment duration for longer than 12 weeks is not currently available under the PBS. Treatment is generally well tolerated, but with the adverse event profile typical for ribavirin.