Table 4.

Regimen-specific recommendations for use of RAS testing in clinical practice[61]

Recommended	*Rating
Elbasvir/grazoprevir  NS5A RAS testing is recommended for genotype 1a-infected, treatment-naive or -experienced patients being considered for elbasvir/grazoprevir. If present, a different regimen should be considered.	I, A
Ledipasvir/sofosbuvir  NS5A RAS testing can be considered for genotype 1a-infected, treatment-experienced patients without cirrhosis being considered for ledipasvir/sofosbuvir. If clinically importanta resistance is present, a different recommended therapy should be used.  NS5A RAS testing can be considered for genotype 1a-infected, treatment-experienced patients with cirrhosis being considered for ledipasvir/sofosbuvir. If clinically importanta resistance is present, a different recommended therapy should be used.	I, A
Sofosbuvir/velpatasvir  NS5A RAS testing is recommended for genotype 3-infected, treatment-naive patients with cirrhosis and treatment-experienced patients (with or without cirrhosis) being considered for 12 weeks of sofosbuvir/velpatasvir. If Y93H is present, weight-based ribavirin should be added or sofosbuvir/velpatasvir/voxilaprevir should be used.	I, A
Daclatasvir plus sofosbuvir  NS5A RAS testing is recommended for genotype 3-infected, treatment-experienced patients without cirrhosis being considered for 12 weeks of daclatasvir plus sofosbuvir. If Y93H is present, weight-based ribavirin should be added.  NS5A RAS testing is recommended for genotype 3-infected, treatment-naive patients with cirrhosis being considered for 24 weeks of daclatasvir plus sofosbuvir. If Y93H is present, treatment should include weight-based ribavirin, or a different recommended therapy used	I, B
NOT RECOMMENDED
Elbasvir/grazoprevir  RAS testing is not recommended for any genotype 1b-infected patients being considered for elbasvir/grazoprevir therapy.	I, A
Glecaprevir/pibrentasvir  RAS testing is not recommended for patients with genotype 1, 2, 3, 4, 5, or 6 infection being considered for glecaprevir/pibrentasvir for 8, 12, or 16 weeks	I, A
Ledipasvir/sofosbuvir  NS5A RAS testing is not recommended for any genotype 1b-infected patients being considered for ledipasvir/sofosbuvir therapy.	I, A
NS5A RAS testing is not recommended for genotype 1a-infected, treatment-naive patients being considered for ledipasvir/sofosbuvir therapy	I, A
NS5A RAS testing is not recommended for genotype 1a- or 1b-infected, treatment-naive patients without cirrhosis and with a viral load <6 million IU/mL being considered for an 8-week course of ledipasvir/sofosbuvir therapy.	I, A
Paritaprevir/ritonavir/ombitasvir with dasabuvir±weight-based ribavirin, or paritaprevir/ritonavir/ombitasvir + weight-based ribavirin  RAS testing is not recommended for genotype 1- or 4-infected, treatment-naive or -experienced patients being considered for therapy with paritaprevir/ritonavir/ombitasvir with dasabuvir±weight-based ribavirin or paritaprevir/ritonavir/ombitasvir + weight-based ribavirin, respectively.	I, A
Sofosbuvir/velpatasvir  RAS testing is not recommended for patients with genotype 1, 2, 4, 5, or 6 infection and considered for 12 weeks of sofosbuvir/velpatasvir therapy.	I, A
Sofosbuvir/velpatasvir/voxilaprevir  RAS testing is not recommended for patients with genotype 1, 2, 3, 4, 5, or 6 infection and considered for 12 weeks of sofosbuvir/velpatasvir/voxilaprevir therapy.	I, A
Clinically important=greater than 100-fold resistance

*I: Evidence and/or general agreement that a given diagnostic evaluation, procedure, or treatment is beneficial, useful, and effective; A: Data derived from multiple randomized clinical trials, meta-analyses, or equivalent; B: Data derived from a single randomized trial, nonrandomized studies, or equivalent