Past Genotype 1 Past Treatment Regimen Current Treatment Options Duration Treatment?
Genotype 1a with Genotype 1a Genotype NS5A RAV* without NS5A Elbasvir/Grazoprevir (Zepatier™) 1b = add Ribavirin RAV* 12 weeks = 16 weeks = 12 weeks HCV RNA <6mil HCV RNA >6mil Ledipasvir/Sofosbuvir (Harvoni®) = 8 weeks** = 12 weeks Genptype Dasabuvir/Ombitasvir/Paritaprevir/ Naive N/A Genotype 1a = 12wks add RBV 1b = Ritonavir (Viekira XR/Pak™) 12 weeks Sofosbuvir/Velpatasvir (Epclusa®) 12 weeks Simeprevir & Sofosbuvir 12 weeks (Olysio® & Sovaldi®) Daclatasvir & Sofosbuvir 12 weeks (Daklinza™ & Sovaldi®) Non- Pegylated interferon & cirrhotic Same as non-cirrhotic, treatment naive Ribavirin Ledipasvir/Sofosbuvir (Harvoni®) 12 weeks Sofosbuvir/Velpatasvir (Epclusa®) 12 weeks Daclatasvir & Sofosbuvir Pegylated interferon & 12 weeks Ribavirin ± Protease Inhibitor (Daklinza™ & Sovaldi®) Elbasvir/Grazoprevir (Zepatier™) Experienced Genotype1a with NS5A baseline RAV* & Ribavirin 12 weeks = 16 weeks
Sofosbuvir & Ribavirin ± Ledipasvir/Sofosbuvir (Harvoni®) + 12 weeks Pegylated interferon Ribavirin
NS5A Inhibitor or Simeprevir & Sofosbuvir STOP – Consult Liver Specialist (Olysio® & Sovaldi®)
*RAV = resistance associated variant **Not recommended in persons with IL-28b polymorphism CT or TT, African Americans, or with HIV co-infection. Past Genotype 1 Past Treatment Regimen Current Treatment Options Duration Treatment? Genotype 1a with Genotype 1a Genotype NS5A RAV* without Elbasvir/Grazoprevir (Zepatier™) 1b = add Ribavirin NS5A RAV* 12 weeks = 16 weeks = 12 weeks HCV RNA <6 mil HCV RNA >6 mil Ledipasvir/Sofosbuvir (Harvoni®) = 8 weeks = 12 weeks Genotype Naive N/A Dasabuvir/Ombitasvir/Paritaprevir/Ritonavir Genotype 1a = 24 weeks add Ribavirin 1b = (Viekira XR/Pak™) 12 weeks Sofosbuvir/Velpatasvir (Epclusa®) 12 weeks Simeprevir & Sofosbuvir (Olysio® & Sovaldi®) 12 weeks Daclatasvir & Sofosbuvir 12 weeks (Daklinza™ & Sovaldi®) Genotype Genotype 1a without NS5A RAV* = 12 Elbasvir/Grazoprevir (Zepatier™) 1b = weeks 12 weeks
Cirrhosis Pegylated interferon & Ledipasvir/Sofosbuvir (Harvoni®) & Ribavirin 12 weeks Ribavirin Sofosbuvir/Velpatasvir (Epclusa®) 12 weeks Dasabuvir/Ombitasvir/Paritaprevir/Ritonavir 12 weeks (Genotype 1b only) (Viekira XR/Pak™) Experienced – Ledipasvir/Sofosbuvir (Harvoni®) With Ribavirin 12 weeks Without Ribavirin 24 weeks Compensated Cirrhosis Sofosbuvir/Velpatasvir (Epclusa®) 12 weeks Only Pegylated interferon & (Child-Pugh: Daclatasvir & Sofosbuvir (Daklinza™ & Ribavirin ± Protease Inhibitor 24 weeks Class A) Sovaldi®) ± Ribavirin Genotype1a with baseline NS5A RAV* = Elbasvir/Grazoprevir (Zepatier™) & Ribavirin 12 weeks 16 weeks
Sofosbuvir & Ribavirin ± Ledipasvir/Sofosbuvir (Harvoni®) & Ribavirin 24 weeks Pegylated interferon
NS5A Inhibitor or Simeprevir & Sofosbuvir STOP – Consult Liver Specialist (Olysio® & Sovaldi®) Decompensated Cirrhosis STOP – Consult Liver Specialist
*RAV = resistance associated variant Past Past Genotype 2 Current Treatment Options Duration Treatment? Regimen
Naive N/A Sofosbuvir/Velpatasvir (Epclusa®) 12 weeks
Pegylated Non-cirrhotic interferon & Sofosbuvir/Velpatasvir (Epclusa®) 12 weeks or Ribavirin Compensated Cirrhosis Experienced (Child-Pugh: Daclatasvir & Sofosbuvir (Daklinza™ & Sovaldi®) ± Ribavirin 24 weeks Class A) Sofosbuvir & Ribavirin Sofosbuvir/Velpatasvir (Epclusa®) + Ribavirin 12 weeks
Decompensated Cirrhosis STOP – Consult Liver Specialist Past Past Genotype 3* Current Treatment Options Duration Treatment? Regimen
Daclatasvir & Sofosbuvir (Daklinza™ & Sovaldi®) 12 weeks Naive N/A Sofosbuvir/Velpatasvir (Epclusa®) 12 weeks
Pegylated Daclatasvir & Sofosbuvir (Daklinza™ & Sovaldi®) 12 weeks Non-cirrhotic interferon & Ribavirin Sofosbuvir/Velpatasvir (Epclusa®) 12 weeks Experienced ® Sofosbuvir & Daclatasvir & Sofosbuvir (Daklinza™ & Sovaldi ) + Ribavirin 24 weeks Ribavirin Sofosbuvir/Velpatasvir (Epclusa®) + Ribavirin 12 weeks
Sofosbuvir/Velpatasvir (Epclusa®) 12 weeks Naïve N/A Daclatasvir & Sofosbuvir (Daklinza™ & Sovaldi®) + Ribavirin 24 weeks Compensated Pegylated Sofosbuvir/Velpatasvir (Epclusa®) + Ribavirin 12 weeks Cirrhosis interferon & (Child Pugh: Ribavirin Daclatasvir & Sofosbuvir (Daklinza™ & Sovaldi®) + Ribavirin 24 weeks Class A) Experienced Daclatasvir & Sofosbuvir (Daklinza™ & Sovaldi®) + Ribavirin 24 weeks Sofosbuvir & Ribavirin Sofosbuvir/Velpatasvir (Epclusa®) + Ribavirin 12 weeks
Decompensated Cirrhosis STOP – Consult Liver Specialist
*Preliminary data suggest that NS5A Genotype 3 resistance associated variant (RAV) testing is recommended for all genotype 3 patients prior to treatment.