What is the recommended treatment regimen for a patient with hepatitis C virus (HCV) infection?

From the Guidelines

The recommended treatment for hepatitis C virus (HCV) infection is a direct-acting antiviral (DAA) regimen, such as glecaprevir/pibrentasvir (Mavyret) for 8-12 weeks, depending on the presence of liver cirrhosis and HCV genotype, as supported by the most recent guidelines 1.

Key Considerations

• Treatment duration and regimen selection depend on the HCV genotype, presence of liver cirrhosis, and treatment experience.
• Genotype testing, assessment of liver fibrosis, and screening for potential drug interactions are essential before initiating treatment.
• The standard dosing for common DAAs includes:
  • Glecaprevir/pibrentasvir (Mavyret): three tablets (total 300mg glecaprevir/120mg pibrentasvir) once daily with food.
  • Sofosbuvir/velpatasvir (Epclusa): one tablet (400mg sofosbuvir/100mg velpatasvir) daily.
  • Ledipasvir/sofosbuvir (Harvoni): one tablet (90mg ledipasvir/400mg sofosbuvir) daily.

Treatment Regimens by Genotype

• For HCV genotype 1, ledipasvir/sofosbuvir or glecaprevir/pibrentasvir can be used for 8-12 weeks, depending on the presence of cirrhosis and treatment experience 1.
• For HCV genotype 3, daclatasvir and sofosbuvir, or glecaprevir/pibrentasvir, can be used for 12 weeks, with or without ribavirin, depending on the presence of cirrhosis and treatment experience 1.
• For HCV genotypes 5 and 6, ledipasvir/sofosbuvir, daclatasvir and sofosbuvir, or glecaprevir/pibrentasvir can be used for 8-12 weeks, depending on the presence of cirrhosis and treatment experience 1.

Monitoring and Follow-up

• Regular monitoring during treatment includes blood tests to assess viral load, liver function, and potential adverse effects.
• Treatment outcomes are typically assessed 12 weeks after completion of therapy to determine sustained virologic response (SVR).

From the FDA Drug Label

Table 1 shows the recommended treatment regimen and duration based on patient population. For patients with HCV/HIV-1 coinfection follow the dosage recommendations in Table 1 For treatment-naïve and treatment-experienced liver transplant recipients without cirrhosis or with compensated cirrhosis (Child-Pugh A), the recommended regimen is sofosbuvir and velpatasvir once daily for 12 weeks

The recommended treatment regimen for a patient with Hepatitis C Virus (HCV) infection is:

• Sofosbuvir and velpatasvir once daily for 12 weeks for treatment-naïve and treatment-experienced patients without cirrhosis or with compensated cirrhosis (Child-Pugh A) 2
• Ledipasvir and sofosbuvir once daily for 12 weeks for treatment-naïve patients with genotype 1,4,5, or 6 HCV without cirrhosis or with compensated cirrhosis (Child-Pugh A) 3 Key considerations:
• Patient population: Treatment regimen and duration may vary based on patient population, including treatment-naïve or treatment-experienced patients, and presence of cirrhosis or HIV-1 coinfection.
• HCV genotype: Treatment regimen may vary based on HCV genotype, with different regimens recommended for genotype 1,4,5, or 6 HCV.

From the Research

Treatment Regimens for Hepatitis C Virus (HCV) Infection

The recommended treatment regimen for a patient with HCV infection depends on various factors, including the genotype of the virus, the presence of cirrhosis, and prior treatment experience.

• The combination of sofosbuvir and velpatasvir has been shown to be effective in treating HCV genotypes 1-6, with high sustained virological response (SVR) rates in clinical trials and real-world settings 4, 5.
• For patients with HCV genotype 3, the addition of ribavirin to the sofosbuvir and velpatasvir regimen may be beneficial, particularly in those with cirrhosis 6.
• The treatment regimen for patients coinfected with HCV and HIV-1 is similar to that for patients with HCV alone, with sofosbuvir and velpatasvir being a recommended option 7.
• Patient-reported outcomes, such as quality of life and symptom severity, have been shown to improve with treatment using sofosbuvir and velpatasvir, with or without voxilaprevir 8.

Efficacy of Sofosbuvir and Velpatasvir

• The efficacy of sofosbuvir and velpatasvir has been demonstrated in several clinical trials, with SVR rates ranging from 95% to 99% in patients with HCV genotypes 1-6 4, 5, 7.
• The regimen has been shown to be effective in patients with and without cirrhosis, as well as in those who have been previously treated for HCV 4, 5.
• The addition of voxilaprevir to the sofosbuvir and velpatasvir regimen may be beneficial in patients who have been previously treated with direct-acting antivirals 8.

Safety and Tolerability

• The safety and tolerability of sofosbuvir and velpatasvir have been evaluated in several clinical trials, with the regimen being generally well-tolerated 4, 5, 7.
• Common adverse events include fatigue, headache, and upper respiratory tract infection 4, 5, 7.
• Serious adverse events are rare, and the regimen has been shown to be safe in patients with and without cirrhosis, as well as in those who have been previously treated for HCV 4, 5, 7.