The combination of sofosbuvir plus velpatasvir is a safe and effective treatment for Gt 2 HCV (Sofosbuvir plus velpatasvir and Tables 3 and 4). The recommended treatment duration is 12 weeks for all patients. Cure rates > 95% were observed in clinical trials, including among people with cirrhosis. [34]
The combination of glecaprevir plus pibrentasvir is a safe and effective treatment for Gt 2 HCV (Glecaprevir plus pibrentasvir and Tables 3 and 4). The recommended treatment duration is 8 weeks for people with no cirrhosis and 12 weeks for people with cirrhosis. Cure rates > 95% were observed in clinical trials. [36]
The combination of sofosbuvir plus ribavirin for 12 weeks is no longer recommended as first-line treatment 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.
This regimen is effective in people with no cirrhosis, with overall cure rates of 90%–95%. [52-55] 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%. [53]
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%). [55] 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.