Overview of Antiviral Therapy for HCV

Antiviral drugs for chronic hepatitis C virus (HCV or hep C) infection have changed the way the condition is treated. Today, HCV is a largely curable disease with these treatments.

Treatment is customized for each person based on several factors, such as:1

  • The specific genotype (strain) of HCV a person has
  • If the person has been treated for HCV before
  • If they have liver damage (cirrhosis)
  • If they have other conditions, like HIV
  • If they have had a liver transplant

Treatment recommendations for HCV

The American Association for the Study of Liver Diseases (AASLD) and Infectious Diseases Society of America (ISDA) have created guidelines for how people with chronic HCV should be treated based on these factors. However, because the HCV treatment options can change quickly as new medicines become available, these guidelines also change.

Talk with your doctor about which treatments may be best for you.

Treatments for people who have never had treatment for hep C

People with chronic HCV who have not had any treatment for their infection are called “treatment naïve.” The treatment options are based on the specific genotype, as well as whether the person has cirrhosis.

For people with all genotypes who are treatment naïve and do not have cirrhosis, the recommended drugs are:1

  • Mavyret (glecaprevir/pibrentasvir)
  • Epclusa (sofosbuvir/velpatasvir)

For people with all genotypes who are treatment naïve and who have compensated cirrhosis, the recommended drug is Mavyret (glecaprevir/pibrentasvir).1

For people with genotypes 1, 2, 4, 5, or 6 who are treatment naïve and who have compensated cirrhosis, another drug option is Epclusa (sofosbuvir/velpatasvir).1

Treatments for people who have had previous treatment for hep C

Sometimes, 1 drug does not work for a person. This means that it did not cure their HCV. For those who have previously been treated, the recommended drug depends on:1

  • Their genotype
  • Whether they have cirrhosis or not
  • Which type of drug they tried earlier

The drugs that may be recommended include:1

  • Zepatier (elbasvir/grazoprevir)
  • Mavyret (glecaprevir/pibrentasvir)
  • Harvoni (ledipasvir/sofosbuvir)
  • Epclusa (sofosbuvir/velpatasvir)

Ribavirin may need to be added to the treatment regimen for some people.

Vosevi® (sofosbuvir/velpatasvir/voxilaprevir) may be recommended for certain people with:

  • Genotype 1, 2, 4, 5, or 6 with or without cirrhosis
  • Genotype 3 who do not have cirrhosis

Hep C treatments for people with HIV

For those who have both hep C and HIV, treatment for both conditions must be taken into account. It is important for people who have hep C and HIV to communicate their conditions with all their doctors. This is because treatment for HIV may need to change during hep C treatment.1

The recommended hep C treatment options for people with HIV include:1

  • Zepatier (elbasvir/grazoprevir)
  • Mavyret (glecaprevir/pibrentasvir)
  • Epclusa (sofosbuvir/velpatasvir)
  • Harvoni (ledipasvir/sofosbuvir)
  • Vosevi (sofosbuvir/velpatasvir/voxilaprevir)

Treatments for people with cirrhosis

Chronic HCV can cause cirrhosis (scarring of the liver). Cirrhosis can be known as:1

  • Compensated – Not causing symptoms.
  • Decompensated – Symptoms are present. This includes jaundice, swelling, bleeding in the esophagus or stomach, and changes in mood or behavior.

Treatment recommendations for people with compensated cirrhosis are based on their genotype and whether they have had treatment before. These treatment recommendations are outlined above.1

For people who have decompensated cirrhosis, most will benefit from treatment with direct-acting antivirals (DAAs). However, treatment may not be enough to prevent needing a liver transplant.1

The recommended treatments for people with decompensated cirrhosis are dependent on the genotype of HCV and other conditions they may have. This includes anemia (low red blood cell count), kidney disease, or pregnancy. People with these conditions should not take regimens that include ribavirin.1

For people with all genotypes who are treatment naïve and who have compensated cirrhosis, the recommended drug is Mavyret (glecaprevir/pibrentasvir).1

For people with genotypes 1, 2, 4, 5, or 6 who are treatment naïve and have compensated cirrhosis, another drug option is Epclusa (sofosbuvir/velpatasvir).1

Treatments for people who have had a liver transplant

In most cases, a liver transplant does not cure HCV. People who have had a liver transplant may need to take drugs for HCV. Treatment is based on genotype and whether or not the person has cirrhosis.

Recommended drugs for people who have had a liver transplant with any genotype and do not have cirrhosis are:1

  • Mavyret (glecaprevir/pibrentasvir)
  • Epclusa (sofosbuvir/velpatasvir)
  • Harvoni (ledipasvir/sofosbuvir) (for genotypes 1, 4, 5, or 6 only)

Recommended drugs for treatment-naïve people who have had a liver transplant with any genotype and have compensated cirrhosis are:1

  • Epclusa (sofosbuvir/velpatasvir)
  • Mavyret (glecaprevir/pibrentasvir)
  • Harvoni (ledipasvir/sofosbuvir) plus ribavirin (for genotypes 1, 4, 5, or 6 only)

Recommended drugs for treatment-naïve people who have had a liver transplant with any genotype who have decompensated cirrhosis are:1

  • Harvoni (ledipasvir/sofosbuvir) plus ribavirin (for genotypes 1, 4, 5, or 6 only)
  • Epclusa (sofosbuvir/velpatasvir)

The recommended drug for people who have had a liver transplant with any genotype who have taken direct-acting antivirals (DAAs) before is Vosevi (sofosbuvir/velpatasvir/voxilaprevir).1

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Written by: Editorial Team | Last reviewed: March 2021