. 2017 Jan;13(1):22–31.

Table.

Guide for HCV Infection Management in Both Initial Treatment and Treatment-Experienced Failures

Genotype	Available Regimens
1	Sofosbuvir/velpatasvir: 12 weeks treatment
	For decompensated cirrhosis, add ribavirin^a For decompensated cirrhosis and for sofosbuvir or NS5A failure, add ribavirin: 24 weeks treatment
	Elbasvir/grazoprevir: 12 weeks treatment
	In genotype 1a, check RAVs to NS5A; if positive: 16 weeks treatment For NS3/protease inhibitor+pegylated interferon/ribavirin-experienced patients, add ribavirin; if +RAVs to NS5A: 16 weeks treatment Not for post–liver transplant or decompensated cirrhosis
	Sofosbuvir/ledipasvir: 12 weeks treatment
	Naive, noncirrhotic, non–African American, and <10⁶ copies: 8 weeks treatment For decompensated cirrhosis, NS3A/protease inhibitor+pegylated interferon/ribavirin-experienced with cirrhosis, or post–liver transplant, add ribavirin^a If sofosbuvir/ribavirin-experienced, add ribavirin: 12 weeks treatment; if cirrhotic,^b add ribavirin: 24 weeks treatment
	Paritaprevir/ritonavir/ombitasvir+dasabuvir: 12 weeks treatment
	If genotype 1a or 1, add ribavirin If cirrhotic, caution (per FDA) genotype 1b: 12 weeks treatment; genotype 1a or 1, add ribavirin: 24 weeks treatment
	Sofosbuvir/simeprevir: 12 weeks treatment
	If NS5A-experienced, avoid in genotype 1a if +NS3 Q80K
	Sofosbuvir/daclatasvir: 12 weeks treatment
	If cirrhotic or NS3/protease inhibitor+pegylated interferon/ribavirin-experienced, ± ribavirin: 24 weeks treatment For decompensated cirrhosis, add ribavirin^a
2	Sofosbuvir/velpatasvir: 12 weeks treatment
	For decompensated cirrhosis, add ribavirin
	Sofosbuvir/daclatasvir: 12 weeks treatment
	If cirrhotic, 16-24 weeks treatment For decompensated cirrhosis, add ribavirin: 12 weeks treatment If sofosbuvir/ribavirin-experienced, ± ribavirin: 24 weeks treatment
3	Sofosbuvir/velpatasvir: 12 weeks treatment
	For decompensated cirrhosis, pegylated interferon/ribavirin-experienced, or sofosbuvir/ribavirin-experienced, add ribavirin
	Sofosbuvir/elbasvir/grazoprevir: 12 weeks treatment
	If cirrhotic and/or treatment-experienced, ± ribavirin: 12 weeks treatment
	Sofosbuvir/daclatasvir: 12 weeks treatment
	If cirrhotic ± ribavirin: 24 weeks treatment If sofosbuvir/ribavirin-experienced, add ribavirin: 24 weeks treatment For decompensated cirrhosis, add ribavirin: 12 weeks treatment
4	Sofosbuvir/velpatasvir: 12 weeks treatment
	For decompensated cirrhosis, add ribavirin^a If sofosbuvir/NS5A-experienced, add ribavirin: 24 weeks treatment
	Sofosbuvir/ledipasvir: 12 weeks treatment
	For decompensated cirrhosis, add ribavirin^a If pegylated interferon/ribavirin-experienced and cirrhotic, add ribavirin^a If sofosbuvir-experienced, add ribavirin
	Elbasvir/grazoprevir: 12 weeks treatment
	For treatment-experienced, if failure to suppress virus on prior treatment, add ribavirin: 16 weeks treatment Not for post–liver transplant or decompensated cirrhosis
	Paritaprevir/ritonavir/ombitasvir+ribavirin: 12 weeks treatment
	If cirrhotic, caution (per FDA), add ribavirin If pegylated interferon/ribavirin-experienced, add ribavirin
5	Sofosbuvir/velpatasvir: 12 weeks treatment
	Sofosbuvir/ledipasvir: 12 weeks treatment
	If sofosbuvir-experienced or post–liver transplant, add ribavirin
6	Sofosbuvir/velpatasvir: 12 weeks treatment
	Sofosbuvir/ledipasvir: 12 weeks treatment
	If sofosbuvir-experienced or post–liver transplant, add ribavirin

FDA, US Food and Drug Administration; HCV, hepatitis C virus; NS, nonstructural; Q80K, hepatitis C virus polymorphism; RAVs, resistance-associated variants.

If patient is ribavirin-intolerant, extend duration of treatment to 24 weeks.

Cirrhosis refers to compensated cirrhosis unless stated as decompensated cirrhosis.

Developed by Dr Vargas and Dr Horsley-Silva, copyright of Mayo Foundation for Medical Education and Research, 2016.