Hepatitis C treatment: where are we now?

Figures & data

Figure 1 Genotype 1 is the most common cause of chronic hepatitis C infection worldwide. Reproduced from Messina JP, Humphreys I, Flaxman A, et al. Global distribution and prevalence of hepatitis C virus genotypes. Hepatology. 2015;61(1):77–87. Creative Commons license and disclaimer available from: http://creativecommons.org/licenses/by/4.0/legalcode.⁵

Abbreviation: HCV, hepatitis C virus.

Figure 2 Distribution of GT1a versus GT1b. Reproduced from Messina JP, Humphreys I, Flaxman A, et al. Global distribution and prevalence of hepatitis C virus genotypes. Hepatology. 2015;61(1):77–87. Creative Commons license and disclaimer available from: http://creativecommons.org/licenses/by/4.0/legalcode.⁵

Abbreviations: GT, genotype; HCV, hepatitis C virus.

Figure 3 Hepatitis C virus polyprotein structure.

Abbreviation: HCV, hepatitis C virus.

Table 1 Directly acting antivirals and sites of action

Protease inhibitor
NS3/4A inhibitor	NS5A inhibitor	NS5B inhibitor
Telaprevir	Daclatasvir	Sofosbuvir
Boceprevir	Ledipasvir	Dasabuvir
Simeprevir	Elbasvir
Grazoprevir	Ombitasvir
Paritaprevir	Velpatasvir
Asunaprevir	Odalasvir
Voxileprevir
Glecaprevir

Table 2 Interferon-free treatment regimens for chronic hepatitis C according to cirrhosis and treatment status, as recommended by the European Association for the Study of the Liver and AASLD

Genotype	No cirrhosis
	Treatment naïve	Treatment experienced
1	SOF/LDV (8–12 weeks)	SOF/LDV ± RBV (12 weeks)a
	SOF/VEL (12 weeks)	SOF/VEL (12 weeks)
	RTV–PTV/OBV/DSV ± RBV (8-12 weeks)b	RTV–PTV/OBV/DSV ± RBV (12 weeks)b
	GZR/EBR (12 weeks)c	GZR/EBR (12 weeks)c
	SOF + DCV (12 weeks)	SOF + DCV ± RBV (12 weeks)a
	SOF + SMV (12 weeks)	SOF + SMV (12 weeks)
2	SOF/VEL (12 weeks)	SOF/VEL (12 weeks)
	SOF + DCV (12 weeks)	SOF + DCV (12 weeks)
3	SOF/VEL (12 weeks)	SOF/VEL ± RBV (12 weeks)d
	SOF + DCV (12 weeks)	SOF + DCV ± RBV (12 weeks)d
4	SOF/LDV (12 weeks)	SOF/LDV ± RBV (12 weeks)d
	SOF/VEL (12 weeks)	SOF/VEL (12 weeks)
	RTV–PTV/OBV + RBV (12 weeks)	RTV–PTV/OBV + RBV (12 weeks)
	GZR/EBR (12 weeks)	GZR/EBR (12 weeks)e
	SOF + DCV (12 weeks)	SOF + DCV ± RBV (12 weeks)d
	SOF + SMV (12 weeks)	SOF + SMV ± RBV (12 weeks)d
5/6	SOF/LDV (12 weeks)	SOF/LDV ± RBV (12 weeks)d
	SOF/VEL (12 weeks)	SOF/VEL (12 weeks)
	SOF + DCV (12 weeks)	SOF + DCV ± RBV (12 weeks)d
Genotype	Cirrhosis
	Compensated: naïve/experienced	Decompensated
1	SOF/LDV ± RBV (12 weeks)f	SOF/LDV + RBV (12 weeks)l
	SOF/VEL (12 weeks)	SOF/VEL + RBV (12 weeks)l
	RTV–PTV/OBV/DSV ± RBV (12/24 weeks)g
	GZR/EBR (12 weeks)h
	SOF + DCV ± RBV (12 weeks)f	SOF + DCV + RBV (12 weeks)l
	SOF + SMV (12 weeks)
2	SOF/VEL (12 weeks)	SOF/VEL + RBV (12 weeks)l
	SOF + DCV (12 weeks)	SOF + DCV + RBV (12 weeks)l
3	SOF/VEL (12 weeks)i	SOF/VEL + RBV (24 weeks)l
	SOF + DCV + RBV (24 weeks)	SOF + DCV + RBV (24 weeks)l
4	SOF/LDV ± RBV (12 weeks)j	SOF/LDV + RBV (12 weeks)l
	SOF/VEL (12 weeks)	SOF/VEL +RBV (12 weeks)l
	RTV–PTV/OBV + RBV (12 weeks)
	GZR/EBR (12 weeks)k
	SOF + DCV ± RBV (12 weeks)j	SOF + DCV + RBV (12 weeks)
	SOF + SMV ± RBV (12 weeks)j
5/6	SOF/LDV ± RBV (12 weeks)j	SOF/LDV + RBV (12 weeks)l
	SOF/VEL (12 weeks)	SOF/VEL + RBV (12 weeks)l
	SOF + DCV ± RBV (12 weeks)j	SOF + DCV + RBV (12 weeks)l

Notes:

a If GT1a, add RBV or extend to 24 weeks without RBV.

b If GT1a, add RBV and treat for 12 weeks.

c If GT1a with viral load >800,000 IU/mL, extend to 16 weeks plus RBV.

d Treat for 12 weeks with RBV or 24 weeks without RBV.

e If viral load >800,000 IU/mL, extend to 16 weeks plus RBV.

f If GT1a treatment-experienced, give 12 weeks with RBV or 24 weeks without.

g If GT1a, 24 weeks with RBV. If GT1b, 12 weeks without RBV.

h If GT1a with viral load >800,000 IU/mL, extend to 16 weeks plus RBV.

i If resistance-associated mutations, give 12 weeks with RBV or 24 weeks without.

j If treatment-experienced, give 12 weeks with RBV or 24 weeks without.

k If treatment-experienced with viral load >800,000 IU/mL, extend to 16 weeks plus RBV.

l If intolerant to RBV, give 24-week therapy without RBV.

Abbreviations: AASLD, American Association for the Study of Liver Diseases; SOF, sofosbuvir; LDV, ledipasvir; RBV, ribavirin; VEL, velpatasvir; RTV, ritonavir; PTV, paritaprevir; OBV, ombitasvir; DSV, dasabuvir; GZR, grazoprevir; EBR, elbasvir; DCV, daclatasvir; SMV, simeprevir; GT, genotype.

MessinaJPHumphreysIFlaxmanAGlobal distribution and prevalence of hepatitis C virus genotypesHepatology2015611778725069599

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