European
guidelines issued by the European Association for the Study of the Liver (ELPA)
in 2016 recommend that anyone with liver
damage or fibrosis stage 2 (moderate liver damage) or above should receive
treatment without delay. In most European countries people with cirrhosis
and genotypes 1, 3 or 4 are being given priority for treatment with newer
interferon-free drug combinations, in order to prevent liver damage progressing
further. At this time, in most countries people without moderate-to-severe
liver damage and without evidence of fast progression of liver disease are less
likely to receive treatment.
Treatment
recommendations differ according to genotype. Some combinations of
direct-acting antivirals are active against all, or several, HCV genotypes.
These are called pan- genotypic drugs. Other direct-acting antivirals are only
active against genotype 1.
The table
below outlines European recommendations for the treatment of each genotype
issued in September 2016. Access to these drugs varies between countries
because of national differences in what form of treatment is funded by
governments.
Glossary
- association
When
there is a statistical relationship between two variables. For example, when A
increases, B increases. An association means that the two variables change
together, but it doesn't necessarily mean that A causes B. The relationship
isn't necessarily causal.
- cirrhosis
Scarring of the liver – the structure of the liver is altered. See also
‘fibrosis’, which is moderate scarring. See also ‘compensated cirrhosis’ and
‘decompensated cirrhosis’.
- compensated cirrhosis
The earlier stage of
cirrhosis, during which the liver is damaged but still able to perform most of
its functions. See also ‘cirrhosis’ and ‘decompensated cirrhosis’.
- decompensated cirrhosis
The later stage of
cirrhosis, during which the liver cannot perform some vital functions and
complications occur. See also ‘cirrhosis’ and ‘compensated cirrhosis’.
- fibrosis
Scarring of the liver
– the development of hard, fibrous tissue. See also ‘cirrhosis’, which is more
severe scarring.
- genotype
A strain or subtype of a virus. For hepatitis C, genotypes are identified by a number (e.g. genotypes 1,2,3,4,5 and 6); some subtypes have also been identified (e.g. genotypes 1a and 1b). For hepatitis B, genotypes are identified by a letter (A to H). The genotype may influence the risk of disease progression for both viruses; some genotypes respond differently to some treatments.
- interferon-free
A treatment regimen that does not include pegylated interferon.
- stage
The stage of hepatitis infection refers to the amount of liver scarring
(fibrosis) detected by biopsy. Usually measured on scales of 0 to 4, or 0 to 6
(higher numbers indicated more severe inflammation).
- treatment-experienced
A person who has previously
taken treatment for a condition.
|
Genotype 1
|
| |
Add ribavirin?
|
Duration
|
Duration if cirrhotic
|
|
Harvoni (sofosbuvir &
ledipasvir)
|
If cirrhotic or treatment-experienced and genotype 1a
|
8-12 weeks
|
12 weeks (24 weeks without ribavirin)
|
|
Viekirax & Exviera
(ombitasvir, paritaprevir & dasabuvir)
|
If genotype 1a
|
12 weeks
|
12 weeks in genotype 1b, 24 weeks in genotype 1a
|
|
Epclusa (sofosbuvir &
ledipasvir)
|
If decompensated cirrhosis
|
12 weeks
|
12 weeks
|
|
Zepatier (elbasvir &
grazoprevir)
|
If viral load is high or baseline resistance to elbasvir in genotype
1a; extend treatment to 16 weeks when using ribavirin
|
12 weeks
|
12 weeks
|
|
Sofosbuvir (Sovaldi) &
daclatasvir (Daklinza)
|
If cirrhotic and genotype 1a or post-transplant
|
12 weeks
|
12 weeks (24 weeks without ribavirin or if cirrhosis is
decompensated)
|
|
Genotype 2
|
|
|
Add ribavirin?
|
Duration
|
Duration if cirrhotic
|
|
Sofosbuvir (Sovaldi) &
daclatasvir (Daklinza)
|
If decompensated cirrhosis
|
12 weeks
|
12 weeks
|
|
Epclusa (sofosbuvir &
velpatasvir)
|
No
|
12 weeks
|
12 weeks
|
|
Genotype 3
|
|
|
Add ribavirin?
|
Duration
|
Duration if cirrhotic
|
|
Sofosbuvir & velpatasvir (Epclusa)
|
If decompensated cirrhosis; consider also in compensated cirrhosis
and treatment-experienced patients without cirrhosis
|
12 weeks (24 weeks in treatment-experienced)
|
12 weeks (24 weeks without ribavirin)
|
|
Sofosbuvir (Sovaldi)/daclatasvir
(Daklinza)
|
If cirrhotic or treatment experienced
|
12 weeks
|
12 weeks treatment-experienced, 24 weeks cirrhotic
|
|
Genotype 4
|
|
|
Add ribavirin?
|
Duration
|
Duration if cirrhotic
|
|
Sofosbuvir & ledipasvir (Harvoni)
|
If cirrhotic or treatment experienced
|
12 weeks
|
12 weeks (24 weeks without ribavirin)
|
|
Ombitasvir/paritaprevir (Viekirax)
|
Yes
|
12 weeks
|
12 weeks
|
|
Sofosbuvir & velpatasvir (Epclusa)
|
If decompensated cirrhosis
|
12 weeks
|
12 weeks
|
|
Elbasvir & grazoprevir (Zepatier)
|
If viral load is high or baseline resistance to elbasvir; extend
treatment to 16 weeks when using ribavirin
|
12 weeks
|
12 weeks
|
|
Sofosbuvir (Sovaldi) &
simeprevir (Olysio)
|
If cirrhotic
|
12 weeks
|
12 weeks (24 weeks without ribavirin)
|
|
Sofosbuvir (Sovaldi) &
daclatasvir (Daklinza)
|
If cirrhotic
|
12 weeks
|
12 weeks (24 weeks without ribavirin or if cirrhosis is
decompensated)
|
|
Genotypes 5 & 6
|
|
|
Add ribavirin?
|
Duration
|
Duration if cirrhotic
|
|
Harvoni (sofosbuvir &
ledipasvir)
|
If cirrhotic or treatment-experienced
|
12 weeks
|
12 weeks (24 weeks without ribavirin)
|
|
Epclusa (sofosbuvir &
ledipasvir)
|
If decompensated cirrhosis
|
12 weeks
|
12 weeks
|
|
Sofosbuvir (Sovaldi) &
daclatasvir (Daklinza)
|
If cirrhotic or treatment-experienced
|
12 weeks
|
12 weeks (24 weeks without ribavirin)
|