People with Gt 1 HCV who did not respond to treatment with a protease inhibitor plus peginterferon-alfa plus ribavirin
The preferred regimen for people with Gt 1 HCV who did not respond to treatment with a protease inhibitor plus pegIFN plus ribavirin is the combination of sofosbuvir plus ledipasvir, or the combination of sofosbuvir plus daclatasvir (Table 3). The combination of elbasvir plus grazoprevir is also effective in this population. Response rates are similar to those observed in treatment-naive individuals.
Non-responders to interferon-free therapy
For people in whom treatment with IFN-free therapy fails, current PBS restrictions do not prohibit patients receiving retreatment with a different IFN-free regimen. However, the evidence to support the use of regimens currently available under the PBS for salvage treatment of HCV is limited, and it is recommended that all individuals in whom first-line DAA therapy fails be referred to a specialist centre where HCV resistance testing is available and there is greater access to evolving salvage treatment strategies via clinical trials. Retreatment with the same treatment regimen is not recommended. Salvage strategies should include combination therapy with the addition of at least one new class of agent (NS5B polymerase inhibitor, NS5A inhibitor, protease inhibitor or ribavirin) and consideration of longer treatment duration. Triple-therapy regimens (NS5B, NS5A and NS3 inhibitors) and regimens involving next-generation agents with improved resistance profiles that are currently being tested in clinical trials look very promising.