HCV Treatments by Genotype

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 HCV in patients both with and without cirrhosis. The hope is that these simplified guidelines will increase the number of healthcare professionals who can treat hepatitis C. While treatment options can vary based on genotype, most patients qualify for the simplified treatment algorithm. Special considerations remain for pediatric patients, as well as those with HIV/HCV coinfection, decompensated cirrhosis, history of liver or kidney transplant, or 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:

  • If you are treatment naïve (never been treated for HCV before)
  • 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 U.S., doctors often follow guidelines from the American Association for the Study of Liver Diseases and the Infectious Disease Society of America. Guidelines for the treatment of hep C change often as new drugs become available and doctors learn more about how to successfully treat hep C.

Types of drugs used to treat HCV

Currently, the 3 main classes of drugs used to treat hep C are direct-acting antivirals (DAA’s), interferon, and ribavirin.

Interferon and ribavirin were the first drugs used to treat hep C. These were hard for patients to take and had low cure rates, mainly due to difficult side effects and how long treatment lasted. Today, direct-acting antivirals (DAAs) are the first-line of treatment. DAAs have far fewer side effects and much shorter treatment times (8 to 12 weeks versus 4 to 6 months with earlier treatments).

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

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:

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

If someone has been treated for genotype 2 before and failed treatment, treatments may include:

  • Epclusa (sofosbuvir-velpatasvir) plus Vosevi (voxilaprevir) and ribavirin
  • Mavyret (glecaprevir-pibrentasvir) plus Solvadi (sofosbuvir) and ribavirin

Treatment options for genotype 3

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

  • Mavyret (glecaprevir-pibrentasvir)
  • Epclusa (sofosbuvir-velpatasvir), sometimes with ribavirin added
  • Epclusa (sofosbuvir-velpatasvir) plus Vosevi (voxilaprevir)

If someone has been treated for genotype 3 before and failed treatment, treatments may include:

  • Epclusa (sofosbuvir-velpatasvir), sometimes with Vosevi (voxilaprevir) or ribavirin
  • Mavyret (glecaprevir-pibrentasvir), sometimes with Solvadi (sofosbuvir) and ribavirin
  • Zepatier (elbasvir-grazoprevir), sometimes with Solvadi (sofosbuvir)
  • Epclusa (sofosbuvir-velpatasvir) plus Vosevi (voxilaprevir) or ribavirin

Treatment options for genotype 4

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

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

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

Treatment options for genotype 5 and 6

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

  • Mavyret (glecaprevir-pibrentasvir)
  • Epclusa (sofosbuvir-velpatasvir)
  • Harvoni (ledipasvir-sofosbuvir)

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Last reviewed: March 2021