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HCV Treatment Options
HCV Treatment Options in HCV/HIV Co-infected Persons
Preferred Options
Preferred DAA HCV treatment options (except for persons pre-treated with Protease or NS5A inhibitors)
| HCV GT | Treatment regimen | Treatment duration & RBV usage | ||
| Non-cirrhotic | Compensated cirrhotic | Decompensated cirrhotics CTP class B/C | ||
| 1 & 4 | EBR/GZR | 12 weeks(i) | Not recommended | |
| GLE/PIB |
8 weeks |
8-12 weeks(ii) |
Not recommended |
|
| SOF/VEL |
12 weeks |
12 weeks with RBV(ix) | ||
| SOF/LDV +/- RBV |
8-12 weeks without RBV(iii) |
12 weeks with RBV(iv) |
12 weeks with RBV(ix) |
|
| 2 | GLE/PIB | 8 weeks | 8-12 weeks(ii) | Not recommended |
| SOF/VEL | 12 weeks | 12 weeks with RBV(ix) | ||
| 3 | GLE/PIB |
8 weeks(v) |
8-12 weeks(ii,v) |
Not recommended |
| SOF/VEL +/- RBV |
12 weeks(vi) |
12 weeks with RBV(vii) |
12 weeks with RBV(ix) | |
| SOF/VEL/VOX | - |
12 weeks |
Not recommended |
|
| 5 & 6 | GLE/PIB |
8 weeks |
8-12 weeks(ii) | Not recommended |
| SOF/LDV +/- RBV |
12 weeks +/- RBV(viii) |
12 weeks with RBV(iv) |
12 weeks with RBV(ix) |
|
| SOF/VEL | 12 weeks | 12 weeks with RBV(ix) | ||
For HCV treatment options to be used if preferred options are not available, please see version 10.1 of the EACS Guidelines
EBR = elbasvir
GLE = glecaprevir
GZR = grazoprevir
LDV = ledipasvir
PIB = pibrentasvir
RBV = ribavirin
SOF = sofosbuvir
VEL = velpatasvir
VOX = voxilaprevir
RAS = resistance associated substitutions
- In persons with GT1a with baseline HCV-RNA < 800,000 IU/mL and/or absence of NS5A RASs, as well as in treatment-naïve persons with GT4 with HCV-RNA < 800,000 IU/mL In GT 1b treatment-naïve PLWH with F0-F2 fibrosis 8 weeks can be considered
- 8 weeks treatment can be considered in treatment naïve persons
- 8 weeks treatment without RBV only in treatment-naïve persons with F < 3 and baseline HCV-RNA < 6 million IU/mL
- RBV can be omitted in treatment-naïve or -experienced persons with compensated cirrhosis without baseline NS5A RAS. In persons intolerant to RBV, treatment may be prolonged to 24 weeks
- Treatment duration in HCV GT3 who failed previous treatment with IFN and RBV +/- SOF or SOF and RBV should be 16 weeks
- In treatment experienced persons RBV should be added unless NS5A RASs are excluded; if these persons are intolerant to RBV, treatment may be prolonged to 24 weeks without RBV
- If RAS testing is available and demonstrates absence of NS5A RAS Y93H, RBV can be omitted in treatment naive people with compensated cirrhosis
- In treatment experienced (exposure to IFN/RBV/SOF) persons add RBV treatment for 12 weeks or prolong treatment to 24 weeks without RBV
- In persons intolerant to RBV, treatment may be prolonged to 24 weeks