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. Links to alternative treatment information is also provided. Always follow your doctor’s instructions regarding any medication and take them exactly as prescribed.

HCV Genotype 1

Recommended Treatments

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 of Zepatier along with ribavirin 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.

Mavyret (glecaprevir/pibrentasvir)

  • Recommended dosage: Three Mavyret tablets (daily dose consists of glecaprevir 300 mg/pibrentasvir 120 mg) taken one time daily with food
  • Duration for treatment-naïve patients:
    • 8 weeks without cirrhosis
    • 12 weeks with compensated cirrhosis
  • Duration for treatment-experienced patients:
    • 16 weeks for patients with or without cirrhosis that were previously treated with a regimen containing an NS5A inhibitor without prior treatment with an NS3/4A protease inhibitor
    • 12 weeks for patients with or without cirrhosis that were previously treated with a regiment containing NS3/4A protease inhibitor without prior treatment with an NS5A inhibitor.
    • 8 weeks for patients without cirrhosis that were previously treated with a regimen that contained interferon, peginterferon, ribavirin, and/or sofosbuvir (PRS).
    • 12 weeks for patients with compensated cirrhosis that were previously treated with a regimen that contained PRS.
  • In clinical trials, the most common adverse reactions (≥10%) were headache and fatigue.

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).

Epclusa (sofosbuvir/velpatasvir)

  • Recommended dosage:  One tablet (which consists of 400 mg sofosbuvir and 100 mg velpatasvir) taken one time daily with or without food.
  • Duration:
    • 12 weeks for treatment-naïve or treatment-experienced patients with or without cirrhosis
    • 12 weeks Epclusa with ribavirin for treatment-naïve or treatment-experienced 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%) in patients with decompensated cirrhosis were fatigue, anemia, nausea, headache, insomnia and diarrhea.

For alternative regimens please visit The American Association for the Study of Liver Diseases.

 

HCV Genotype 2

Recommended Treatments

Mavyret (glecaprevir/pibrentasvir)

  • Recommended dosage: Three Mavyret tablets (daily dose consists of glecaprevir 300 mg/pibrentasvir 120 mg) taken one time daily with food
  • Duration for treatment-naïve patients:
    • 8 weeks without cirrhosis
    • 12 weeks with compensated cirrhosis
  • Duration for treatment-experienced patients:
    • 8 weeks for patients without cirrhosis that were previously treated with a regimen that contained interferon, peginterferon, ribavirin, and/or sofosbuvir (PRS).
    • 12 weeks for patients with compensated cirrhosis that were previously treated with a regimen that contained PRS.
  • In clinical trials, the most common adverse reactions (≥10%) 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 or without food.
  • Duration:
    • 12 weeks for treatment-naïve or treatment-experienced patients with or without cirrhosis
    • 12 weeks Epclusa with ribavirin for treatment-naïve or treatment-experienced 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%) in patients with decompensated cirrhosis were fatigue, anemia, nausea, headache, insomnia and diarrhea.

For alternative regimens please visit The American Association for the Study of Liver Diseases.

 

HCV Genotype 3

Recommended Treatments

Mavyret (glecaprevir/pibrentasvir)

  • Recommended dosage: Three Mavyret tablets (daily dose consists of glecaprevir 300 mg/pibrentasvir 120 mg) taken one time daily with food
  • Duration for treatment-naïve patients:
    • 8 weeks without cirrhosis
    • 12 weeks with compensated cirrhosis
  • Duration for treatment-experienced patients:
    • 16 weeks for patients without cirrhosis that were previously treated with a regimen that contained interferon, peginterferon, ribavirin, and/or sofosbuvir (PRS).
    • 16 weeks for patients with compensated cirrhosis that were previously treated with a regimen that contained PRS.
  • In clinical trials, the most common adverse reactions (≥10%) 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 or without food.
  • Duration:
    • 12 weeks for treatment-naïve or treatment-experienced patients with or without cirrhosis
    • 12 weeks Epclusa with ribavirin for treatment-naïve or treatment-experienced 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%) in patients with decompensated cirrhosis were fatigue, anemia, nausea, headache, insomnia and diarrhea.

For alternative regimens please visit The American Association for the Study of Liver Diseases.

HCV Genotype 4

Recommended Treatments

Mavyret (glecaprevir/pibrentasvir)

  • Recommended dosage: Three Mavyret tablets (daily dose consists of glecaprevir 300 mg/pibrentasvir 120 mg) taken one time daily with food
  • Duration for treatment-naïve patients:
    • 8 weeks without cirrhosis
    • 12 weeks with compensated cirrhosis
  • Duration for treatment-experienced patients:
    • 8 weeks for patients without cirrhosis that were previously treated with a regimen that contained interferon, peginterferon, ribavirin, and/or sofosbuvir (PRS).
    • 12 weeks for patients with compensated cirrhosis that were previously treated with a regimen that contained PRS.
  • In clinical trials, the most common adverse reactions (≥10%) 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 or without food.
  • Duration:
    • 12 weeks for treatment-naïve or treatment-experienced patients with or without cirrhosis
    • 12 weeks Epclusa with ribavirin for treatment-naïve or treatment-experienced 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%) in patients with decompensated cirrhosis 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
    • 16 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.

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
  • In clinical trials, the most common adverse reactions (≥10%) were fatigue , headache and physical weakness (asthenia).

For alternative regimens please visit The American Association for the Study of Liver Diseases.

 

HCV Genotype 5 or 6

Recommended Treatments

Mavyret (glecaprevir/pibrentasvir)

  • Recommended dosage: Three Mavyret tablets (daily dose consists of glecaprevir 300 mg/pibrentasvir 120 mg) taken one time daily with food
  • Duration for treatment-naïve patients:
    • 8 weeks without cirrhosis
    • 12 weeks with compensated cirrhosis
  • Duration for treatment-experienced patients:
    • 8 weeks for patients without cirrhosis that were previously treated with a regimen that contained interferon, peginterferon, ribavirin, and/or sofosbuvir (PRS).
    • 12 weeks for patients with compensated cirrhosis that were previously treated with a regimen that contained PRS.
  • In clinical trials, the most common adverse reactions (≥10%) 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 or without food.
  • Duration:
    • 12 weeks for treatment-naïve or treatment-experienced patients with or without cirrhosis
    • 12 weeks Epclusa with ribavirin for treatment-naïve or treatment-experienced 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%) in patients with decompensated cirrhosis 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 weeks for treatment-naïve and treatment-experienced patients without cirrhosis or with compensated cirrhosis
  • In clinical trials, the most common adverse reactions (≥10%) were fatigue , headache and physical weakness (asthenia).

For alternative regimens please visit The American Association for the Study of Liver Diseases.

 

Last Updated: October 2017

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.