HCV Treatments by Genotype

Reviewed by: HU Medical Review Board | Last reviewed: May 2023

In August 2020, the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) released simplified guidelines for the treatment of hepatitis C virus (HCV) in people both with and without cirrhosis.1

The hope is that these simplified guidelines will increase the number of doctors who can treat HCV. While treatment options can vary based on genotype, most people qualify for the simplified treatment algorithm. Special considerations remain for:1

  • Children with HCV
  • People with HIV/HCV coinfection
  • Those with decompensated cirrhosis
  • People with a history of liver or kidney transplant
  • Those in end-stage renal disease (ESRD)

Factors influencing hep C treatment options

How your hepatitis C (HCV) is treated will depend on several factors. The first is the genotype of your virus. Other factors include:1

  • If you have been treated for HCV before (treatment naïve)
  • If you have cirrhosis of the liver
  • Your age
  • If you have other health issues
  • If you have tried other HCV treatments before and which ones

In the United States, doctors often follow guidelines from the AASLD and the IDSA. Guidelines for HCV treatment change often as new drugs become available and doctors learn more about how to successfully treat hep C.1

Types of drugs used to treat HCV

Currently, the 3 main classes of drugs used to treat HCV are:1

Interferon and ribavirin were the first drugs used to treat hep C. These were hard for people to take and had low cure rates. This was mainly due to difficult side effects and how long treatment lasted.1

Today, DAAs are the first line of treatment. DAAs have far fewer side effects. They also have much shorter treatment times – 8 to 12 weeks versus 4 to 6 months with earlier treatments.1

Ribavirin and interferon may still be used in combination with other treatments when DAAs do not work.1

Treatment options for genotype 1

Genotype 1 HCV was once the hardest to treat. Now, there are 6 DAAs that treat genotypes 1a and 1b. For people with genotype 1a or 1b HCV without cirrhosis or with compensated cirrhosis, who are either treatment-naïve, the treatment options are:1

Treatment options for genotype 2

People with HCV genotype 2, without cirrhosis or with compensated cirrhosis, may be treated with:1

  • Mavyret
  • Epclusa

Treatment options for genotype 3

People with HCV genotype 3, without cirrhosis or with compensated cirrhosis, may be treated with:1

  • Mavyret
  • Epclusa, sometimes with ribavirin added
  • Daily fixed-dose combination of sofobuvir (400mg)/velpatasvir (100 mg)/voxilaprevir (100 mg) for patients with baseline NS5A RAS Y93H for valpatasvir

If someone has been treated for genotype 3 before and failed treatment, new treatment options will be based on what drugs have been tried previously.1

Treatment options for genotype 4

Genotype 4 treatments for people without cirrhosis or with compensated cirrhosis include:1

  • Mavyret
  • Harvoni
  • Epclusa
  • Zepatier

Ribavirin, Vosevi, or Solvadi may be added to these drugs if the person has tried certain other treatments for HCV.1

Treatment options for genotype 5 and 6

Genotypes 5 and 6 treatments for people without cirrhosis or with compensated cirrhosis, include:1

  • Mavyret
  • Epclusa
  • Harvoni

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