Hepatitis C: The Basics : What is the recommended treatment for hepatitis C?
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What is the recommended treatment for hepatitis C?

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), viral load, 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.

There are a number of approved therapies to treat HCV, such as Harvoni (sofosbuvir/ledipasvir), Sovaldi (sofosbuvir) and Olysio (simeprevir). Sovaldi and Olysio may be prescribed together, or each may be separately combined with ribavirin and in some cases peginterferon as well. Although Victrelis (boceprevir) plus ribavirin and peginterferon is also approved, this regimen is associated with increased side effects and longer duration of treatment, and is therefore not considered a preferred regimen.

When hepatitis C treatment is working, the virus will become undetectable within four to 12 weeks and will remain 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 Infectious Diseases Society of America (IDSA). Note: In December 2014, the AASLD and IDSA will announce new recommendations regarding the use of Harvoni (sofosbuvir/ledipasvir):

AASLD HCV Treatment Recommendations
for treatment-naive patients who are eligible to receive interferon
Recommended Alternative
Genotype 1 Sovaldi + ribavirin + PEG* for 12 weeks Olysio for 12 weeks + ribavirin + PEG* for 24 weeks**
Genotype 2 Sovaldi + ribavirin for 12 weeks none
Genotype 3 Sovaldi + ribavirin for 24 weeks Sovaldi + ribavirin + PEG* for 12 weeks
Genotype 4 Sovaldi + ribavirin + PEG* for 12 weeks Olysio for 12 weeks + ribavirin + PEG* for 24–28 weeks
Genotype 5 or 6 Sovaldi + ribavirin + PEG* for 12 weeks ribavirin + PEG* for 48 weeks


AASLD HCV Treatment Recommendations
for treatment-naive patients who are NOT eligible to receive interferon
Recommended Alternative
Genotype 1 Sovaldi + Olysio +/- ribavirin for 12 weeks Sovaldi + ribavirin for 24 weeks***
Genotype 2 Sovaldi + ribavirin for 12 weeks none
Genotype 3 Sovaldi + ribavirin for 24 weeks none
Genotype 4 Sovaldi + ribavirin for 24 weeks none
Genotype 5 or 6 none none


* PEG = peginterferon
** For people with either HCV genotype 1b or HCV genotype 1a and in whom the Q80K polymorphism is not detected before treatment
*** Preliminary data suggest this regimen may be less effective than the recommended regimen, particularly among those with cirrhosis.


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 has been less effective for African Americans than for Caucasians. This is partly-but not completely-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 Sovaldi 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 there was no apparent difference in success rates with the drug among Latinos than among non-Latinos.

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Last Revised: December 04, 2014

This content is written by the Hep editorial team.

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