Hepatitis C Virus Treatments

HEPATITIS C VIRUS TREATMENTS
Hepatitis C virus (HCV) management for treatment-naive patients is based on HCV genotype and the presence or absence of cirrhosis. The following lists the recommended treatments and duration of therapy for genotypes 1 through 6. For management of treatment-experienced patients or those with multiple treatment failures, please refer to the AASLD-IDSA’s HCV guidelines or the full drug labeling.
			With Decompensated Cirrhosis¹
Genotype	Without Cirrhosis	With Compensated Cirrhosis	Ribavirin Eligible	Ribavirin Ineligible
TREATMENT NAIVE
Genotype 1a	• Mavyret for 8wks OR • Harvoni for 12wks² OR • Epclusa for 12wks Alternative: • Zepatier¹⁰ for 12wks	• Harvoni for 12wks OR • Epclusa for 12wks OR • Mavyret for 8wks Alternative: • Zepatier¹⁰ for 12wks	• Epclusa + ribavirin⁶ for 12wks OR • Harvoni + ribavirin⁴ for 12wks	• Epclusa for 24wks OR Harvoni for 24wks
Genotype 1b	• Zepatier for 12wks⁵ OR • Mavyret for 8wks OR • Harvoni for 12wks^2,7 OR • Epclusa for 12wks	• Zepatier for 12wks OR • Harvoni for 12wks OR • Epclusa for 12wks OR • Mavyret for 8wks	• Epclusa + ribavirin⁶ for 12wks OR • Harvoni + ribavirin⁴ for 12wks	• Epclusa for 24wks OR Harvoni for 24wks
Genotype 2	• Mavyret for 8wks OR • Epclusa for 12wks	• Epclusa for 12wks OR • Mavyret for 8wks	• Epclusa + ribavirin⁶ for 12wks	• Epclusa for 24wks
Genotype 3	• Mavyret for 8wks OR • Epclusa for 12wks	• Mavyret for 8wks OR • Epclusa for 12wks³ Alternative: • Epclusa + ribavirin for 12wks³ OR • Vosevi for 12wks³	• Epclusa + ribavirin⁶ for 12wks	• Epclusa for 24wks
Genotype 4	• Zepatier for 12wks OR • Mavyret for 8wks OR • Harvoni for 12wks⁸ OR • Epclusa for 12wks	• Epclusa for 12wks OR • Mavyret for 8wks⁵ OR • Zepatier for 12wks OR • Harvoni for 12wks	• Epclusa + ribavirin⁶ for 12wks OR • Harvoni + ribavirin⁴ for 12wks	• Epclusa for 24wks OR • Harvoni for 24wks
Genotypes 5 or 6	• Mavyret for 8wks OR • Epclusa for 12wks OR • Harvoni for 12wks⁹	• Mavyret for 8wks OR • Epclusa for 12wks OR • Harvoni for 12wks⁹	• Epclusa + ribavirin⁶ for 12wks OR • Harvoni + ribavirin⁴ for 12wks	• Epclusa for 24wks OR Harvoni for 24wks

Generic	Brand	Strength	Form	Dose
PHARMACOLOGICAL THERAPIES
elbasvir/ grazoprevir	Zepatier	50mg/100mg	tabs	Adults and Children: <12yrs (<30kg): not established. ≥12yrs or ≥30kg: 1 tab once daily.
glecaprevir/ pibrentasvir	Mavyret	100mg/40mg	tabs	Adults and Children: <3yrs: not established. ≥3yrs (<20kg): 150mg/60mg (pellets) once daily; (20–<30kg): 200mg/80mg (pellets) once daily; (30–<45kg): 250mg/100mg (pellets) once daily; (≥45kg): 300mg/120mg (tabs or pellets) once daily. ≥12yrs: 300mg/120mg (tabs or pellets) once daily.
glecaprevir/ pibrentasvir	Mavyret Oral Pellets	50mg/20mg	pellets
ledipasvir/ sofosbuvir	Harvoni	45mg/200mg, 90mg/400mg	tabs	Adults: 90mg/400mg (tabs) once daily. Children: <3yrs: not established. ≥3yrs (<17kg): 33.75mg/150mg (pellets) once daily; (17–<35kg): 45mg/200mg (tabs or pellets) once daily; (≥35kg): 90mg/400mg (tabs or pellets) once daily.
ledipasvir/ sofosbuvir	Harvoni Oral Pellets	33.75mg/150mg, 45mg/200mg	pellets
ribavirin	—	200mg	caps, tabs	Adults: Take with food in 2 divided doses. ≥18yrs (<75kg): 1g/day; (≥75kg): 1.2g/day. Low initial dose: 600mg; increase as tolerated. Children: <3yrs: not established. Take with food in 2 divided doses. ≥3yrs (<47kg): 15mg/kg/day; (47–49kg): 600mg/day; (50–65kg): 800mg/day; (66–80kg): 1g/day; (>80kg): 1.2g/day. Low initial dose: 600mg; increase as tolerated.
sofosbuvir	Sovaldi	200mg, 400mg	tabs	Adults: 400mg (tabs) once daily. Children: <3yrs: not established. ≥3yrs (<17kg): 150mg (pellets) once daily; (17–<35kg): 200mg (tabs or pellets) once daily; (≥35kg): 400mg (tabs or pellets) once daily.
sofosbuvir	Sovaldi Oral Pellets	150mg, 200mg	pellets
sofosbuvir/ velpatasvir	Epclusa	200mg/50mg, 400mg/100mg	tabs	Adults: 400mg/100mg (tabs) once daily. Children: <3yrs: not established. ≥3yrs (<17kg): 150mg/37.5mg (pellets) once daily; (17–<30kg): 200mg/50mg (tabs or pellets) once daily; (≥30kg): 400mg/100mg (tabs or pellets) once daily.
sofosbuvir/ velpatasvir	Epclusa Oral Pellets	150mg/37.5mg, 200mg/50mg	pellets
sofosbuvir/ velpatasvir/ voxilaprevir	Vosevi	400mg/100mg/100mg	tabs	Adults: 1 tab once daily with food. Children: Not established.
NOTES
Key: AASLD-IDSA = American Association for the Study of Liver Diseases and Infectious Diseases Society of America; HCV = hepatitis C virus; PI = protease inhibitor ¹ Includes Child-Turcotte-Pugh (CTP) class B and class C patients who may or may not be candidates for liver transplantation, including those with hepatocellular carcinoma. Any protease inhibitor-containing regimen (eg, glecaprevir, grazoprevir, paritaprevir, simeprevir, voxilaprevir) and interferon-based regimens are not recommended. ² An 8-week duration is recommended for treatment-naïve patients without cirrhosis who are HIV uninfected, and whose HCV RNA level is <6 million IU/ml. ³ Baseline NS5A RAS Y93H testing for velpatasvir is recommended. If baseline NS5A RAS Y93H is present, ribavirin should be added to the regimen, or change regimen to Vosevi. ⁴ Initiate with low-dose ribavirin (600mg) and increase as tolerated to weight-based dosing. ⁵ Duration of 12 weeks is recommended for HIV/HCV co-infection. ⁶ With weight-based ribavirin. For patients with CTP class C cirrhosis, initiate with low-dose ribavirin (600mg) and increase as tolerated. ⁷ Consider an 8-week regimen in patients with genotype 1b and mild fibrosis. ⁸ Consider an 8-week regimen in patients with favorable baseline characteristics (eg, no cirrhosis, HCV RNA <6 million IU/mL, absence of genotype 4r. ⁹ Not recommended for genotype 6e if subtype is known. ¹⁰ NS5A RAS resistance testing is recommended in genotype 1a patients if considering Zepatier therapy. If baseline RASs are present, use another recommended regimen. Not an inclusive list of medications and/or official indications. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling.
REFERENCES
AASLD-IDSA. HCV Guidance: Recommendations for testing, managing, and treating hepatitis C. http://www.hcvguidelines.org. Updated December 19, 2023. Accessed January 10, 2024. (Rev. 1/2024)

Want to read more?