Summary of recommended regimens for treatment-experienced people with HCV

Table 3. Recommended treatment protocols for treatment-experienced people with hepatitis C virus (HCV) infection and compensated liver disease, including people with HCV–HIV coinfection

Salvage regimen (all doses are orally, daily)

Prior treatment history

 

Sofosbuvir

+

NS5A inhibitor

NS3 PI +

NS5A inhibitor

±

NS5B inhibitor

 

Sofosbuvir + RBV

or

PegIFN + RBV + sofosbuvir

PegIFN + RBV

+

NS3 PI

PegIFN + RBV

Sofosbuvir 400 mg

+

Velpatasvir 100 mg

+

Voxilaprevir 100mg

 

Gt 1–6:*^

12 weeks

GT 1–6: *^

12 weeks

GT 1–6: *^

12 weeks

Glecaprevir 300 mg

+

Pibrentasvir 120 mg

Gt 1 only

(PI naive):

16 weeks

 

Gt 1, 2, 4, 5, 6:

No cirrhosis: 
8 weeks

Cirrhosis: 
12 weeks

Gt 3: 16 weeks

 

Gt 1 only

(NS5A inhibitor naive):

12 weeks

Gt 1, 2, 4, 5, 6:

No cirrhosis: 
8 weeks

Cirrhosis: 
12 weeks

Gt 3: 16 weeks

Sofosbuvir 400 mg

+

Velpatasvir 100 mg

 

 

Gt 1b, 2, 4, 5, 6:*

12 weeks§

Gt 1–6:

12 weeks

 

Gt 1–6:

12 weeks§

 

Gt = genotype; HIV = human immunodeficiency virus; OTVF = on-treatment virological failure (null response, partial response, virological breakthrough or rebound, or intolerance to prior treatment); PegIFN = peginterferon; PI = protease inhibitor; RBV = ribavirin.

* Additional benefit of sofosbuvir + velpatasvir + voxilaprevir over sofosbuvir + velpatasvir has not been demonstrated in adults with genotype 1b, 2, 4, 5 or 6 HCV previously treated with sofosbuvir without an NS5A inhibitor.

^ Sofosbuvir + velpatasvir + voxilaprevir is not yet PBS-listed for the treatment of Gt 1–6 HCV in people in whom DAA therapy has previously failed.

† Sofosbuvir + velpatasvir + voxilaprevir is not PBS-listed for the treatment of non-responders to pegIFN + RBV ± NS3 protease inhibitor.

‡ Studies in people with no cirrhosis enrolled very few patients with advanced fibrosis, and we recommend 12 weeks’ treatment in people with advanced fibrosis (liver stiffnesss > 9.5 kPa).