Which hepatitis C virus (HCV) genotypes does Sofosbuvir (sofosbuvir) cover?

Sofosbuvir Covers All Hepatitis C Virus Genotypes (1-6)

Sofosbuvir is effective against all six major HCV genotypes (1-6), making it a pangenotypic treatment option when used in appropriate combinations. 1

Sofosbuvir Coverage by Genotype

Sofosbuvir demonstrates broad antiviral activity against all HCV genotypes, but is typically used in specific combinations to optimize treatment outcomes:

• Genotype 1-6: Sofosbuvir/velpatasvir is FDA-approved for all six genotypes in adults and pediatric patients 3 years and older 1
• Genotype 1-6: When combined with velpatasvir, sofosbuvir achieves SVR rates of:
  • 95-100% in genotype 1 1
  • 100% in genotype 2 1
  • 92-96% in genotype 3 2
  • 100% in genotype 4 1
  • 97% in genotype 5 3
  • 100% in genotype 6 3

Optimal Combinations by Genotype

While sofosbuvir itself has activity against all genotypes, its effectiveness is maximized through specific combinations:

Genotype 1

• Sofosbuvir/ledipasvir for 12 weeks 3
• Sofosbuvir/velpatasvir for 12 weeks 4, 1
• Sofosbuvir/simeprevir for 12 weeks (no cirrhosis) or 24 weeks (with cirrhosis) 3

Genotype 2

• Sofosbuvir/velpatasvir for 12 weeks 3, 1
• Sofosbuvir plus ribavirin for 12 weeks 3

Genotype 3

• Sofosbuvir/velpatasvir for 12 weeks 3, 1
• Sofosbuvir/velpatasvir plus ribavirin for 12 weeks (especially with NS5A resistance-associated substitutions) 2

Genotype 4

• Sofosbuvir/velpatasvir for 12 weeks 1
• Sofosbuvir/simeprevir for 12 weeks 3
• Sofosbuvir/daclatasvir for 12 weeks 3

Genotype 5 and 6

• Sofosbuvir/velpatasvir for 12 weeks 3, 1
• Sofosbuvir/ledipasvir for 12 weeks 3

Special Populations

Sofosbuvir maintains its pangenotypic activity in special populations:

• HIV co-infection: Sofosbuvir/velpatasvir achieves 95% SVR12 across all genotypes in HIV/HCV co-infected patients 5
• Cirrhosis: Efficacy is maintained in compensated cirrhosis across all genotypes 1
• Decompensated cirrhosis: Sofosbuvir/velpatasvir plus ribavirin for 12 weeks is recommended with 94% overall SVR12 1

Clinical Implications

The pangenotypic coverage of sofosbuvir has revolutionized HCV treatment by:

1. Eliminating the need for genotype testing in some treatment scenarios when using sofosbuvir/velpatasvir
2. Providing high cure rates across all genotypes
3. Simplifying treatment algorithms with once-daily dosing
4. Offering options for difficult-to-treat populations

Potential Pitfalls

• Lower SVR rates may occur in genotype 3 patients with cirrhosis when using sofosbuvir without appropriate companion drugs 2
• Drug interactions should be carefully monitored, particularly with proton pump inhibitors and amiodarone 4
• Baseline resistance testing may be needed in certain populations, particularly genotype 3 with NS5A resistance-associated substitutions 2

Sofosbuvir's pangenotypic activity makes it a cornerstone of modern HCV therapy, but optimal outcomes require appropriate companion drugs based on genotype, treatment history, and presence of cirrhosis.