European guidelines issued by the European Association for the Study of the
Liver (EASL) updated in 2020 recommend that everyone with hepatitis C should be
offered treatment and anyone with
liver damage or fibrosis stage 2 (moderate liver damage) or above should
receive treatment without delay.
Some combinations of direct-acting antivirals are active against all HCV
genotypes. These are called pangenotypic drugs. Other direct-acting antivirals
are active against specific genotypes.
Alternative regimens are recommended for genotypes 1b and 3 when drug-drug
interactions prevent the use of a pangenotypic regimen. Glecapravir/pibrentasvir and sofosbuvir/velpatasvir are unsuitable for use with
some types of anti-HIV drugs and doses of some lipid-lowering, anti-platelet
and anti-coagulant drugs may need to be adjusted.
|
Genotype
|
Regimen
|
Special conditions for use
|
|
All genotypes
|
Sofosbuvir/velpatasvir (12 weeks)
|
Add ribavirin, treat for 12 weeks, in people with decompensated cirrhosis,
or 24 weeks without ribavirin
|
|
Glecapravir/pibrentasvir (8 weeks)
|
12 weeks for treatment-experienced people with compensated cirrhosis
|
|
Alternative options for specific genotypes
|
|
Genotype 1b
|
Grazoprevir/elbasvir (12 weeks)
|
|
|
Genotype 3 (compensated cirrhosis)
|
Sofosbuvir/velpatasvir/voxilaprevir (12 weeks)
|
|
|
Glecapravir/pibrentasvir (8-12 weeks previously untreated)
|
16 weeks for treatment-experienced people with compensated cirrhosis
|
|
Genotype 3 (no cirrhosis)
|
Sofosbuvir/velpatasvir
with ribavirin (12 weeks)
|
|
| |
Glecapravir/pibrentasvir (8 weeks previously untreated)
|
12 weeks for treatment-experienced people without cirrhosis
|