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 human immunodeficiency virus (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. Patients should talk with their doctor about which treatments may be best for their situation.

What treatments are recommended for patients 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 all genotypes who are treatment naïve and do not have cirrhosis, the recommended drugs are:1

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

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

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

What treatments are best for patients who have had previous treatment for hep C?

Sometimes, one drug does not work for an individual, meaning that it did not cure their HCV.

For those who have previously been treated, the recommended drug depends on their genotype, whether the person has cirrhosis or not, and 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 patients.

Vosevi® (sofosbuvir/velpatasvir/voxilaprevir) may be recommended for certain people with genotype 1, 2, 4, 5, and 6 with or without cirrhosis, and genotype 3 who do not have cirrhosis.

What hep C treatments are best for hep C patients 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, since the treatment for HIV may need to change during HepC treatment. 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)

What treatments are best for patients who have cirrhosis?

Chronic HCV can cause cirrhosis (scarring of the liver). Cirrhosis can be characterized as compensated (it’s not causing symptoms) or decompensated (symptoms are present, including jaundice, swelling, bleeding in the esophagus or stomach, and changes in mood or behavior). For individuals who have compensated cirrhosis, the treatment recommendations are based on their genotype and whether they have had treatment before. These treatment recommendations are outlined above.2

For individuals who have decompensated cirrhosis, most will benefit from treatment with direct-acting antivirals (DAAs), but the treatment may not be enough to prevent needing a liver transplant. The recommended treatments for people with decompensated cirrhosis are dependent on the genotype of HCV and other conditions they may have, such as anemia (low red blood cell count), kidney disease, or pregnancy. People with these conditions should not take regimens that include ribavirin.

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

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

What treatments are best for patients who have had a liver transplant?

In most cases, a liver transplant does not cure HCV, and 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 who do not have cirrhosis are:1

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

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

  • Epclusa (sofosbuvir/velpatasvir)
  • Mavyret (glecaprevir/pibrentasvir)
  • Harvoni (ledipasvir/sofosbuvir) plus ribavirin (for genotypes 1, 4, 5, and 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, and 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 before is Vosevi (sofosbuvir/velpatasvir/voxilaprevir).1

By providing your email address, you are agreeing to our privacy policy. We never sell or share your email address.

Last reviewed: August 2020