The latest research & treatment news about Hepatitis C infection, diagnosis, symptoms and treatment.

Hepatitis C Treatment By Genotype

With more medications approved for the treatment of Hepatitis C, determining which medication is appropriate for you will be based on various factors. In addition to reviewing your medical history, including other health conditions you may have, all lab results and previous treatments, your doctor will determine which options are best for you based on:

  • Your Hepatitis C virus (HCV) genotype
  • Whether or not you have cirrhosis, and if it’s mild (compensated) or severe (decompensated)
  • If you’re waiting for or you’ve already had a liver transplant

Hepatology published an analysis of over 1,200 studies representing 117 countries and 90% of the global population, whereby it was determined that HCV genotype 1 is the most prevalent worldwide. It comprises 46.2% of all HCV cases, approximately one-third of which are in East Asia. Genotype 3 is the next most prevalent globally (30.1%) and genotypes 2, 4, and 6 are responsible for a total 22.8% of all cases. Genotype 5 comprises <1% of hepatitis c infections.

According to the American Liver Foundation, approximately 75% of those infected in the U.S. have genotype 1 (either 1a or 1b). Only 10% – 20% of HCV infected patients in the U.S. have either genotype 2 or 3.

The recommendations below are separated based on FDA approval of these medications for the listed genotype. These are simply guidelines provided by the American Liver Foundation and American Association for The Study of Liver Diseases. Determining the best regimen for you will be based on your specific situation and medical history. Always follow your doctor’s instructions regarding any medication and take them exactly as prescribed.

HCV Genotype 1

Zepatier (elbasvir/grazoprevir); sometimes given with ribavirin.

  • Recommended dosage: One Zepatier tablet (which consists of elbasvir 50 mg/grazoprevir 100 mg) taken one time daily with or without food.
  • Duration for patients with or without cirrhosis:
    • Genotype 1a, 12 weeks for treatment-naïve or peginterferon alfa + ribavirin experienced patients without baseline NS5A polymorphisms
    • Genotype 1a, 16 weeks for treatment-naïve or peginterferon alfa + ribavirin experienced patients with baseline NS5A polymorphisms
    • Genotype 1b, 12 weeks for treatment-naïve or peginterferon alfa + ribavirin experienced patients
    • Genotype 1a or b, 12 weeks of Zepatier along with ribavirin for peginterferon alfa + ribavirin + HCV NS3/4A protease inhibitor experienced patients
  • In clinical trials, the most common adverse reactions (≥5%) were fatigue, headache and nausea. For those patients receiving Zepatier with ribavirin for 16 weeks, the most common adverse reactions (≥5%) were anemia and headache.

Harvoni (ledipasvir/sofosbuvir); sometimes given with ribavirin.

  • Recommended dosage: One Harvoni tablet (which consists of ledipasvir 90 mg/sofosbuvir 400 mg) taken one time daily with or without food.
  • Duration:
    • 12 weeks for treatment-naïve patients without cirrhosis or with compensated cirrhosis
    • 12 weeks for treatment-experienced patients without cirrhosis
    • 24 weeks for treatment-experienced patients with compensated cirrhosis
    • 12 weeks of Harvoni along with ribavirin for treatment-naïve and treatment-experienced patients with decompensated cirrhosis
    • 12 weeks of Harvoni along with ribavirin for treatment-naïve and treatment-experienced liver transplant recipients without cirrhosis or with compensated cirrhosis
  • In clinical trials, the most common adverse reactions (≥10%) were fatigue , headache and physical weakness (asthenia).

Viekira Pak (ombitasvir/paritaprevir/ritonavir tablets; dasabuvir tablets); sometimes given with ribavirin.

  • Recommended dosage: Two ombitasvir, paritaprevir, ritonavir tablets (12.5/75/50 mg) once daily (in the morning) and one dasabuvir tablet (250 mg) twice daily (morning and evening) with a meal.
  • Duration:
    • Genotype 1a, 12 weeks Viekira Pack along with ribavirin for patients without cirrhosis
    • Genotpye 1a, 24 weeks Viekira Pak along with ribavirin for patients with compensated cirrhosis
    • Genotpye 1b, 12 weeks Viekira Pak for patients with or without compensated cirrhosis
  • In clinical trials, the most commonly reported adverse reactions (>10%) of subjects receiving Viekira Pak with ribavirin, were fatigue, nausea, pruritus, other skin reactions, insomnia and physical weakness (asthenia). In trail subjects receiving Viekira Pak without ribavirin, the most commonly reported adverse reactions ( ≥5% of subjects) were nausea, pruritus and insomnia.

Sovaldi (sofosbuvir) plus Olysio (simeprevir); sometimes given with ribavirin and peginterferon alfa.

  • Recommended dosage:  One Olysio capsule (150 mg) taken one time daily with food and one Sovaldi tablet (400 mg) taken one time daily with or without food.
  • Duration:
    • 12 weeks patients without cirrhosis
    • 24 weeks for patients with compensated cirrhosis
    • For certain genotype 1 patients without cirrhosis or with compensated cirrhosis Olysio may be prescribed with peginterferon alfa + ribavirin for a 12 week duration (and would not include Sovaldi)
  • In clinical trials, the most common adverse events reported with Olysio/Sovaldi combination during 12 or 24 weeks of treatment were fatigue, headache and nausea. For those patients receiving Olysio with peginterferon alfa + ribavirin during the first 12 weeks of treatment, the most commone adverse events were rash (which included photosensitivity), pruritus and nausea.

Epclusa (sofosbuvir/velpatasvir)

  • Recommended dosage:  One tablet (which consists of 400 mg sofosbuvir and 100 mg velpatasvir) taken one time daily with food.
  • Duration:
    • 12 weeks for patients without cirrhosis and patients with compensated cirrhosis
    • 12 weeks Epclusa with ribavirin for patients with decompensated cirrhosis
  • In clinical trials, the most common adverse reactions (≥10%) for patients taking just Epclusa were fatigue and headache. For those patients receiving Epclusa with ribavirin the most common adverse reactions (≥10%) were fatigue, anemia, nausea, headache, insomnia and diarrhea.

Sovaldi (sofosbuvir) and Daklinza (daclatasvir)

  • Recommended dosage: One Sovaldi tablet (400 mg) with one Daklinza tablet (60 mg) taken once a day.
  • Duration:
    • 12 weeks for patients without cirrhosis or with compensated cirrhosis
    • 12 weeks along with ribavirin for patients with decompensated cirrhosis or post-transplant
  • The most common adverse events (≥10%) observed with Sovaldi in combination with Daklinza were headache and fatigue. For those also taking this combination with ribavirin, most common adverse reaction (≥10%) were headache, anemia, fatigue and nausea.

 

HCV Genotype 2

Epclusa (sofosbuvir/velpatasvir)

  • Recommended dosage:  One tablet (which consists of 400 mg sofosbuvir and 100 mg velpatasvir) taken one time daily with food.
  • Duration:
    • 12 weeks for patients without cirrhosis and patients with compensated cirrhosis
    • 12 weeks Epclusa with ribavirin for patients with decompensated cirrhosis
  • In clinical trials, the most common adverse reactions (≥10%) for patients taking just Epclusa were fatigue and headache. For those patients receiving Epclusa with ribavirin the most common adverse reactions (≥10%) were fatigue, anemia, nausea, headache, insomnia and diarrhea.

Sovaldi (sofosbuvir) plus ribavirin

  • Recommended dosage: One Sovaldi tablet (400 mg) taken once a day with or without food and weight-based ribavirin (<75 kg = 1000 mg and ≥ 75 kg = 1200 mg) taken in two divided doses daily with food.
  • Duration: 12 weeks.
  • The most common adverse events (≥20%, all grades) observed with Sovaldi in combination with ribavirin were fatigue and headache.

 

HCV Genotype 3

Sovaldi (sofosbuvir) and Daklinza (daclatasvir)

  • Recommended dosage: One Sovaldi tablet (400 mg) with one Daklinza tablet (60 mg) taken once a day.
  • Duration: 12 weeks for patients without cirrhosis;  12 weeks in combination with ribavirin for patients with cirrhosis or post-transplant.
  • The most common adverse events (≥10%) observed with Sovaldi in combination with Daklinza were headache and fatigue.

Epclusa (sofosbuvir/velpatasvir)

  • Recommended dosage:  One tablet (which consists of 400 mg sofosbuvir and 100 mg velpatasvir) taken one time daily with food.
  • Duration:
    • 12 weeks for patients without cirrhosis and patients with compensated cirrhosis
    • 12 weeks Epclusa with ribavirin for patients with decompensated cirrhosis
  • In clinical trials, the most common adverse reactions (≥10%) for patients taking just Epclusa were fatigue and headache. For those patients receiving Epclusa with ribavirin the most common adverse reactions (≥10%) were fatigue, anemia, nausea, headache, insomnia and diarrhea.

HCV Genotype 4

Harvoni (ledipasvir/sofosbuvir)

  • Recommended dosage: One Harvoni tablet (which consists of ledipasvir 90 mg/sofosbuvir 400 mg) taken one time daily with or without food.
  • Duration:
    • 12 week in combination with ribavirin for treatment-naïve and treatment-experienced liver transplant recipients without cirrhosis, or with compensated cirrhosis
    • 12 weeks for treatment-naïve and treatment-experienced patients without cirrhosis or with compensated cirrhosis
  • The most common adverse reactions were fatigue and headache.

Technivie (ombitasvir/paritaprevir/ritonavir) plus ribavarin

  • Recommended dosage: Two Technivie tablets (12.5/75/50 mg) once daily (in the morning) with a meal without regard to fat or calorie content and weight-based ribavirin.
  • Duration: 12 weeks
  • The common side effects for Technivie with ribavirin include tiredness, nausea, itching, sleep problems, feeling weak and skin reactions such as redness or rash.

Epclusa (sofosbuvir/velpatasvir)

  • Recommended dosage:  One tablet (which consists of 400 mg sofosbuvir and 100 mg velpatasvir) taken one time daily with food.
  • Duration:
    • 12 weeks for patients without cirrhosis and patients with compensated cirrhosis
    • 12 weeks Epclusa with ribavirin for patients with decompensated cirrhosis
  • In clinical trials, the most common adverse reactions (≥10%) for patients taking just Epclusa were fatigue and headache. For those patients receiving Epclusa with ribavirin the most common adverse reactions (≥10%) were fatigue, anemia, nausea, headache, insomnia and diarrhea.

Zepatier (elbasvir/grazoprevir); sometimes given with ribavirin.

  • Recommended dosage: One Zepatier tablet (which consists of elbasvir 50 mg/grazoprevir 100 mg) taken one time daily with or without food.
  • Duration for patients with or without cirrhosis:
    • 12 weeks for treatment-naïve patients
    • 12 weeks of Zepatier along with ribavirin for peginterferon alfa + ribavirin experienced patients
  • In clinical trials, the most common adverse reactions (≥5%) were fatigue, headache and nausea. For those patients receiving Zepatier with ribavirin for 16 weeks, the most common adverse reactions (≥5%) were anemia and headache.

 

HCV Genotype 5 or 6

Epclusa (sofosbuvir/velpatasvir)

  • Recommended dosage:  One tablet (which consists of 400 mg sofosbuvir and 100 mg velpatasvir) taken one time daily with food.
  • Duration:
    • 12 weeks for patients without cirrhosis and patients with compensated cirrhosis
    • 12 weeks Epclusa with ribavirin for patients with decompensated cirrhosis
  • In clinical trials, the most common adverse reactions (≥10%) for patients taking just Epclusa were fatigue and headache. For those patients receiving Epclusa with ribavirin the most common adverse reactions (≥10%) were fatigue, anemia, nausea, headache, insomnia and diarrhea.

Harvoni (ledipasvir/sofosbuvir)

  • Recommended dosage: One Harvoni tablet (which consists of ledipasvir 90 mg/sofosbuvir 400 mg) taken one time daily with or without food.
  • Duration:
    • 12 week in combination with ribavirin for treatment-naïve and treatment-experienced liver transplant recipients without cirrhosis, or with compensated cirrhosis
    • 12 weeks for treatment-naïve and treatment-experienced patients without cirrhosis or with compensated cirrhosis
  • The most common adverse reactions were fatigue and headache.

 

Last Updated: November 2016

Global Distribution and Prevalence of Hepatitis C Virus Genotypes. http://onlinelibrary.wiley.com/enhanced/doi/10.1002/hep.27259/, Hepatology. 28 July 2014. Retrieved May 4, 2015.

Hepatitis C: The Basics. http://www.hepmag.com/articles/2512_24160.shtml Hep. Retrieved May 4, 2015.

Highlights of Prescribing Information - HARVONI. http://www.gilead.com/~/media/Files/pdfs/medicines/liver-disease/harvoni/harvoni_pi.pdf, Gilead Sciences, Inc. Retrieved May 4, 2015.

Highlights of Prescribing Information - OLYSIO. http://www.olysio.com/shared/product/olysio/prescribing-information.pdf, Janssen Products, LP. Retrieved May 4, 2015.

Highlights of Prescribing Information - SOVALDI. http://www.gilead.com/~/media/Files/pdfs/medicines/liver-disease/sovaldi/sovaldi_pi.pdf, Gilead Sciences, Inc. Retrieved May 4, 2015.

Highlights of Prescribing Information - VIEKIRA PAK. http://www.rxabbvie.com/pdf/viekirapak_pi.pdf, AbbVie, Inc. Retrieved May 4, 2015.

Initial Treatment of HCV Infection. http://www.hcvguidelines.org/full-report/initial-treatment-hcv-infection, American Association for the Study of Liver Diseases. Retrieved February 10, 2016.

Medication Regimens According to HCV Genotype. http://hepc.liverfoundation.org/treatment/the-basics-about-hepatitis-c-treatment/medication-regimens-according-to-genotype/, American Liver Foundation. Retrieved November 23, 2015.