Past Genotype 1 Past Treatment Regimen Current Treatment Options Duration Treatment?
Genotype 1a Genotype 1a with NS5A Genotype without NS5A Elbasvir/Grazoprevir (Zepatier™) RAS* 1b = RAS* add Ribavirin 12 weeks = 12 weeks = 16 weeks HCV RNA <6mil HCV RNA >6mil Ledipasvir/Sofosbuvir (Harvoni®) Naive N/A = 8 weeks** = 12 weeks Dasabuvir/Ombitasvir/Paritaprevir/Rito Genptype1b = navir (Viekira XR/Pak™) 12 weeks Glecaprevir/Pibrentasvir (Mavyret™) 8 weeks Sofosbuvir/Velpatasvir (Epclusa®) 12 weeks Pegylated interferon & Same as non-cirrhotic, treatment naive Ribavirin Ledipasvir/Sofosbuvir (Harvoni®) 12 weeks Sofosbuvir/Velpatasvir (Epclusa®) 12 weeks Non- cirrhotic Pegylated interferon & Glecaprevir/Pibrentasvir (Mavyret™) 12 weeks Ribavirin ± Protease Inhibitor Elbasvir/Grazoprevir (Zepatier™) & 12 Genotype1a with NS5A baseline RAS* Ribavirin weeks = 16 weeks
Ledipasvir/Sofosbuvir (Harvoni®) + 12 weeks Experienced Ribavirin
Glecaprevir/Pibrentasvir (Mavyret™) 12 weeks Sofosbuvir & Ribavirin ± Sofosbuvir/Velpatasvir (Epclusa®) Pegylated interferon 12 weeks
Sofosbuvir/VelpatasvirVoxilaprevir (Vosevi®) 12weeks
NS5A Inhibitor or STOP – Consult Liver Simeprevir & Sofosbuvir *RAS = resistance associated Substitution Specialist (Olysio® & Sovaldi®) **Not recommended in African Americans, or w/ HIV co-infection. Past Past Treatment Genotype 1 Current Treatment Options Duration Treatment? Regimen 12 Genotype1a w/ NS5A Elbasvir/Grazoprevir (Zepatier™) weeks RAS*= 16 weeks Ledipasvir/Sofosbuvir (Harvoni®) 12 weeks Naive N/A Dasabuvir/Ombitasvir/Paritaprevir/R Genotype 1b = 12 weeks itonavir (Viekira XR/Pak™) Glecaprevir/Pibrentasvir 12 weeks (Mavyret™) Sofosbuvir/Velpatasvir (Epclusa®) 12 weeks Pegylated interferon & Same as compensated cirrhotic, treatment naïve except not Harvoni ® Ribavirin Glecaprevir/Pibrentasvir 12 weeks Compensated (Mavyret™) Cirrhosis Pegylated interferon & Sofosbuvir/Velpatasvir (Epclusa®) 12 weeks Ribavirin ± Protease Inhibitor Genotype1a w/ NS5A Elbasvir/Grazoprevir (Zepatier™) & 12 Experienced – RAS*= Ribavirin (alternative) weeks Compensated 16 weeks Cirrhosis Glecaprevir/Pibrentasvir Only 12 weeks (Child-Pugh: (Mavyret™) Sofosbuvir & Ribavirin Class A) Sofosbuvir/Velpatasvir (Epclusa®) 12 weeks (Genotype 1b) ± Pegylated interferon Sofosbuvir/Velpatasvir/Voxilaprevir 12 weeks (Genotype 1a) (Vosevi®) NS5A Inhibitor or Simeprevir & STOP – Consult Liver Specialist Sofosbuvir (Olysio® & Sovaldi®) Decompensated Cirrhosis STOP – Consult Liver Specialist
*RAS = resistance associated variant Past Past Genotype 2 Current Treatment Options Duration Treatment? Regimen
Glecaprevir/Pibrentasvir (Mavyret™) 8 weeks Naive N/A Sofosbuvir/Velpatasvir (Epclusa®) 12 weeks
Pegylated Glecaprevir/Pibrentasvir (Mavyret™) 8 weeks Non-cirrhotic interferon & Ribavirin Sofosbuvir/Velpatasvir (Epclusa®) 12 weeks Experienced Glecaprevir/Pibrentasvir (Mavyret™) 12 weeks Sofosbuvir & Ribavirin Sofosbuvir/Velpatasvir (Epclusa®) + Ribavirin 12 weeks
Glecaprevir/Pibrentasvir (Mavyret™) 12 weeks Naive N/A Sofosbuvir/Velpatasvir (Epclusa®) 12 weeks Compensated Cirrhosis (Child-Pugh: Pegylated Glecaprevir/Pibrentasvir (Mavyret™) 12 weeks Class A) interferon & Experienced Ribavirin or Sofosbuvir Sofosbuvir/Velpatasvir (Epclusa®) 12 weeks & Ribavirin
Decompensated Cirrhosis STOP – Consult Liver Specialist Past Past Genotype 3* Current Treatment Options Duration Treatment? Regimen
Glecaprevir/Pibrentasvir (Mavyret™) 8 weeks Naive N/A Sofosbuvir/Velpatasvir (Epclusa®) 12 weeks
Glecaprevir/Pibrentasvir (Mavyret™) 16 weeks Pegylated Non-cirrhotic interferon & Sofosbuvir/Velpatasvir (Epclusa®) 12 weeks Ribavirin Experienced Sofosbuvir/Velpatasvir/Voxilaprevir (Vosevi®) 12 weeks
® Sofosbuvir & Daclatasvir & Sofosbuvir (Daklinza™ & Sovaldi ) + Ribavirin 24 weeks Ribavirin Sofosbuvir/Velpatasvir (Epclusa®) + Ribavirin 12 weeks
Sofosbuvir/Velpatasvir (Epclusa®)* 12 weeks Naïve N/A Glecaprevir/Pibrentasvir (Mavyret™) 12 weeks
Compensated Pegylated Cirrhosis interferon & Glecaprevir/Pibrentasvir (Mavyret™) 16 weeks (Child Pugh: Ribavirin Or Class A) Experienced Sofosbuvir & Sofosbuvir/Velpatasvir/Voxilaprevir (Vosevi®) 12 weeks Ribavirin DAA (NS5A Stop- Consult Liver Specialist 12 weeks Inhibitor)
Decompensated Cirrhosis STOP – Consult Liver Specialist
*NS5A Genotype 3 resistance associated substitution (RAS) testing recommended