Hepatitis C Treatment : Hepatitis C Treatment-Naive Recommendations
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Hepatitis C Treatment-Naive Recommendations

The goal of HCV treatment is to cure the virus, which can be done with a combination of drugs. The specific meds used and the duration of treatment depend on a number of factors, including HCV genotype (genetic structure of the virus), past treatment experience, degree of liver damage, ability to tolerate the prescribed treatment, and whether the person is waiting for a liver transplant or is a transplant recipient. In some cases, HCV treatment may be limited by your health insurance plan or drug formulary.

There are a number of approved therapies to treat HCV, such as Harvoni (sofosbuvir/ledipasvir), Daklinza (daclatasvir), Olysio (simeprevir), Sovaldi (sofosbuvir), Technivie and Viekira Pak. Sovaldi and Olysio may be prescribed together with or without ribavirin, or each may be separately combined with ribavirin and in some cases peginterferon as well. Harvoni is two drugs formulated in to one daily pill, whereas Technivie and Viekira Pak are a combination of medications that may be prescribed with or without ribavirin.

When hepatitis C treatment is working, the virus usually becomes undetectable within four to 12 weeks and remains that way throughout treatment. People are considered cured when they have achieved what is known as a sustained virologic response (SVR), or continuation of this undetectable status, 12 to 24 weeks after completing therapy.

Here are the recommendations for HCV treatment for all genotypes from the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA):

AASLD HCV Treatment Recommendations
for Treatment-Naive Patients without Decompensated Cirrhosis or Certain Co-existing Medical Conditions, such as HIV or Kidney Disease
Recommended* Alternative
Genotype 1a Daklinza + Sovaldi for 12 weeks (no cirrhosis) or 24 weeks with/without ribavirin (cirrhosis)
OR
Harvoni for 12 weeks**
OR
Olysio + Sovaldi for 12 weeks (no cirrhosis)
or 24 weeks with/without ribavirin (cirrhosis without Q80K polymorphism)
OR
Viekira Pak + ribavirin for 12 weeks (no cirrhosis)
or 24 weeks with/without ribavirin (cirrhosis)
Olysio + PEG*** + ribavirin for 12 weeks, followed by 12 more weeks of PEG + ribavirin (24 weeks total treatment) with/without cirrhosis****
Genotype 1b Daklinza + Sovaldi for 12 weeks (no cirrhosis) or 24 weeks with/without ribavirin (cirrhosis)
OR
Harvoni for 12 weeks**
OR
Olysio + Sovaldi for 12 weeks (no cirrhosis)
or 24 weeks with/without ribavirin (cirrhosis)
OR
Viekira Pak for 12 weeks
(+ ribavirin with cirrhosis)
n/a
Genotype 2 Daklinza + Sovaldi for 12 weeks if ribavirin-intolerant
OR
Sovaldi + ribavirin for 12 weeks
(16 weeks with cirrhosis)
none
Genotype 3 Daklinza + Sovaldi for 12 weeks (no cirrhosis) or 24 weeks with/without ribavirin (cirrhosis)
OR
Sovaldi + ribavirin + PEG*** for 12 weeks
Sovaldi + ribavirin for 24 weeks
Genotype 4 Harvoni for 12 weeks
OR
Sovaldi + ribavirin for 24 weeks
OR
Technivie + ribavirin for 12 weeks

Olysio + Sovaldi with/without
ribavirin for 12 weeks
OR
Sovaldi + ribavirin + PEG*** for 12 weeks
Genotype 5 Harvoni for 12 weeks Sovaldi + ribavirin + PEG*** for 12 weeks
Genotype 6 Harvoni for 12 weeks Sovaldi + ribavirin + PEG*** for 12 weeks


* When more than one treatment is recommended, they are listed alphabetically
** 8 weeks may be considered in patients without cirrhosis who have pre-treatment HCV RNA less than 6 million IU/mL
*** PEG = peginterferon
**** FDA-approved revisions to the prescribing information 09/2015


For more information about the different classes of HCV treatment and a list of approved HCV treatment, click here.

Does treatment work for African Americans?

Historically, HCV treatment was less effective for African Americans than for Caucasians. This is partly explained by genetics: Researchers identified a gene that is linked with response to pegylated interferon-based treatment, called IL-28B (see "How is it diagnosed, and what tests are used?" for more information on IL-28B). However, clinical trials of new generation of HCV drugs did not find any difference in cure rates between black and non-black study participants.

Does treatment work for Latinos?

Hepatitis C seems to progress more rapidly in Latinos than in people from other racial and ethnic groups. However, in the clinical trials of Sovaldi and other new HCV antivirals, there was no apparent difference in success rates with the drug among Latinos than among non-Latinos.

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Last Revised: January 04, 2016

This content is written by the Hep editorial team.

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