Summary of recommended regimens for treatment-experienced people with HCV

Table 4. 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§

 

Sofosbuvir 400 mg

+

Ledipasvir 90 mg

 

 

 

 

Gt 1:

No cirrhosis: 
12 weeks

Cirrhosis: 
24 weeks

Gt 1:

No cirrhosis: 
12 weeks

Cirrhosis: 
24 weeks

Elbasvir 50 mg

+

Grazoprevir 100 mg

±

Ribavirin 1000/1200 mg

 

 

 

 

Gt 1b:
12 weeks (no RBV)

Gt 1a relapser: 12 weeks

OTVF: 16 weeks + RBV

Gt 1b:

12 weeks (no RBV)

Gt 1a relapser:12 weeks

OTVF: 16 weeks + RBV

Sofosbuvir 400 mg

+

Daclatasvir 60 mg

±

Ribavirin 1000/1200 mg

 

 

 

 

Gt 1:

24 weeks

Gt 1, 3:

No cirrhosis: 
12 weeks

Cirrhosis: 
24 weeks (or 12 weeks + RBV)

PI = protease inhibitor. RBV = ribavirin. OTVF = on-treatment virological failure (null response, partial response, virological breakthrough or rebound, or intolerance to prior treatment).

* 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).

§ Addition of ribavirin may be considered for patients with Gt 3 HCV and compensated cirrhosis. Ribavirin dosing is weight-based; recommended dose is 1000 mg for people weighing < 75 kg and 1200 mg for people weighing ≥ 75 kg.

¶ Relapser = patient who failed to achieve sustained virological response despite achieving an end-of-treatment response.