Table 3.

Treatment Options for Patients Failed by DAA-containing Regimens

Previous DAA experience	Genotype or subtype	Presence of cirrhosis	AASLD/IDSA recommendati on (rating)	Treatment duration	Alternative regimens according to AASLD/IDSA
1. No NS5A inhibitor exposure
Boceprevir, telaprevir, or simeprevir
	1 (+4)*	no cirrhosis	sofosbuvir/ledipasvir (A) sofosbuvir/velp atasvir (A)	12 weeks	Elbasvir/grazoprevir for 12-16 weeks depending on subtype and baseline NS5A RAS
			glecaprevir/pibr entasvir (B)
		with cirrhosis	sofosbuvir/velp atasvir (A) glecaprevir/pibr entasvir (B)		sofosbuvir/ledipasvir + RBV 12-16 weeks depending on HCV subtype and baseline NS5A RAS
Sofosbuvir-containing regimen
	1a	no cirrhosis	sofosbuvir/velp atasvir/voxilapr evir, and (A) glecaprevir/pibr entasvir (B)	12 weeks	sofosbuvir/ledipasvir + ribavirin 12 weeks (except simpepravir failures)
	1b	no cirrhosis	glecaprevir/pibr entasvir (B) sofosbuvir/velp atasvir(B)	12 weeks	sofosbuvir/ledipasvir + RBV 12 weeks (except simeprevir failures)
	1a	with cirrhosis	sofosbuvir/velp atasvir/voxilapr evir (A) glecaprevir/pibr entasvir (B)	12 weeks	NA
	1b	with cirrhosis	glecaprevir/pibr entasvir (B) sofosbuvir/velpatasvir (B)	12 weeks	NA
	2	± cirrhosis	sofosbuvir/velpatasvir (B) glecaprevir/pibr entasvir (B)	12 weeks	NA
	3, 4, 5, and 6	± cirrhosis	sofosbuvir/velp atasvir/voxilapr evir (A)	12 weeks	NA
2. NS5A inhibitor experience
Any regimen containing an NS5A inhibitor	All genotypes (1, 2, 3, 4, 5, and 6)	± cirrhosis	sofosbuvir/velp atasvir/voxilapr evir (A) For genotype 3 and cirrhosis adding ribavirin is recommended (C)	12 weeks	Only for type 1: glecaprevir/pibrentasvir for 16 weeks if no NS3/4 PI pretreatment (B) **Other triple regimens with early data under evaluation (see text)

Note: according to AASLD /IDSA guideline 2018

^*HCV Type 4 is not specifically mentioned in the AASLD/ISDA guideline;

^**These regimens were not mentioned in the AASLD/ISDA guidelines