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) 12 weeks(i) Not recommended
GLE/PIB

8 weeks

12 weeks

Not recommended

SOF/VEL

12 weeks

12 weeks

12 weeks with RBV
SOF/LDV +/- RBV

8-12 weeks without RBV(ii)

12 weeks with RBV(iii)

12 weeks with RBV(iii)

2 GLE/PIB 8 weeks 12 weeks Not recommended
SOF/VEL 12 weeks 12 weeks 12 weeks with RBV
3 GLE/PIB

8 weeks(iv)

12 weeks(iv)

Not recommended

SOF/VEL +/- RBV

12 weeks(v)

12 weeks with RBV(vi) or 24 weeks without RBV

12 weeks with RBV(vi) or 24 weeks without RBV
SOF/VEL/VOX -

12 weeks

Not recommended

5 & 6 GLE/PIB

8 weeks

12 weeks Not recommended
SOF/LDV +/- RBV

12 weeks +/- RBV(vii)

12 weeks with RBV(iii)

12 weeks with RBV(iii)

SOF/VEL 12 weeks 12 weeks 12 weeks with RBV
Abbreviations

EBR = elbasvir
GLE = glecaprevir
GZR = grazoprevir
LDV = ledipasvir
PIB = pibrentasvir
RBV = ribavirin
SOF = sofosbuvir
VEL = velpatasvir
VOX = voxilaprevir
RAS = resistance associated substitution

Notes:
  1. Extension of treatment to 16 weeks and addition of RBV in PLWH with GT1a with baseline HCV-RNA > 800.000 IU/mL and/or NS5A RASs
    causing at least 5-fold reduction in activity of EBR to minimise the risk of treatment failure and in HCV GT4 experienced PLWH with HCV-RNA > 800.000 IU/mL. 8 weeks can be considered in GT 1b treatment-naïve with F0-F2
  2. 8 weeks treatment without RBV only in treatment-naïve PLWH with F < 3 and baseline HCV-RNA < 6 million IU/mL
  3. In persons intolerant to RBV, treatment may be prolonged to 24 weeks. RBV can be omitted in treatment-naïve or -experienced PLWH with compensated cirrhosis without baseline NS5A RAS
  4. Treatment duration in HCV GT3 who failed previous treatment with IFN and RBV +/- SOF or SOF and RBV should be 16 weeks
  5. Addition of RBV in treatment experienced PLWH with baseline NS5A RASs, if RAS testing available; if these persons are intolerant to RBV, treatment may be prolonged to 24 weeks without RBV
  6. If RAS testing is available and demonstrates absence of NS5A RAS Y93H, RBV can be omitted in treatment naive PLWH with compensated cirrhosis
  7. In treatment experienced (exposure to IFN/RBV/SOF) PLWH RBV treatment for 12 weeks or prolong treatment to 24 weeks without RBV

Other Options

DAA HCV treatment options (except for persons pre-treated with Protease or NS5A inhibitors) to be used if preferred option is not available

HCV GT

Treatment regimen

Treatment duration & RBV usage

Non-cirrhotic

Compensated cirrhotic

Decompensated cirrhotics CTP class B/C

1 & 4

OBV/PTV/r + DSV

8(i)-12 weeks in GT 1b

12 weeks in GT 1b

Not recommended

OBV/PTV/r + DSV + RBV

12 weeks in GT 1a

24 weeks in GT 1a

Not recommended

OBV/PTV/r + RBV

12 weeks in GT 4

12 weeks in GT 4

Not recommended

SOF + DCV +/- RBV

12 weeks +/- RBV(ii)

12 weeks with RBV(iii)

12 weeks with RBV(iii)

SOF/VEL/VOX

8 weeks(iv)

12 weeks

Not recommended

2

SOF + DCV

12 weeks

12 weeks

12 weeks with RBV

SOF/VEL/VOX

8 weeks(iv)

12 weeks

Not recommended

3

SOF + DCV +/- RBV

12 weeks +/- RBV(v) or 24 weeks without RBV

24 weeks with RBV

24 weeks with RBV

SOF/VEL/VOX

8 weeks(iv)

12 weeks

Not recommended

5 & 6

SOF + DCV +/- RBV

12 weeks +/- RBV or 24 weeks without RBV(vi)

12 weeks with RBV(iii)

12 weeks with RBV(iii)

SOF/VEL/VOX

8 weeks(iv)

12 weeks

Not recommended
Abbreviations
DCV = daclatasvir

DSV = dasabuvir
OBV = ombitasvir
PTV/r = paritaprevir/RTV RBV = ribavirin
SOF = sofosbuvir
VEL = velpatasvir
VOX = voxilaprevir
RAS = resistance associated substitutions

Notes:
  1. 8 weeks treatment without RBV only in PLWH without cirrhosis
  2. Addition of RBV in GT1a treatment experienced PLWH, but not in PLWH without NS5A RASs, if RASs testing is available
  3. In PLWH intolerant to RBV, treatment may be prolonged to 24 weeks. RBV can be omitted in treatment-naïve or -experienced PLWH with compensated cirrhosis without baseline NS5A RAS
  4. Extension of treatment to 12 weeks in DAA treatment experienced PLWH
  5. Addition of RBV only in treatment experienced persons with baseline NS5A RASs, if RAS testing available; if these PLWH are intolerant to RBV, treatment may be prolonged to 24 weeks without RBV
  6. In treatment experienced (exposure to IFN/RBV/SOF) PLWH RBV treatment for 12 weeks or prolong treatment to 24 weeks without RBV