HCV Treatment Options

HCV Treatment Options in HCV/HIV Co-infected Persons

Preferred Options

Preferred DAA HCV treatment options (except for persons pre-treated with Protease or NS5A inhibitors)

HCV GT Treatment regimen Treatment duration & RBV usage
Non-cirrhotic Compensated cirrhotic Decompensated cirrhotics CTP class B/C
1 & 4 EBR/GZR 12 weeks(i) Not recommended
GLE/PIB

8 weeks

8-12 weeks(ii)

Not recommended

SOF/VEL

12 weeks

12 weeks with RBV(ix)
SOF/LDV +/- RBV

8-12 weeks without RBV(iii)

12 weeks with RBV(iv)

12 weeks with RBV(ix)

2 GLE/PIB 8 weeks 8-12 weeks(ii) Not recommended
SOF/VEL 12 weeks 12 weeks with RBV(ix)
3 GLE/PIB

8 weeks(v)

8-12 weeks(ii,v)

Not recommended

SOF/VEL +/- RBV

12 weeks(vi)

12 weeks with RBV(vii) 

12 weeks with RBV(ix)
SOF/VEL/VOX -

12 weeks

Not recommended

5 & 6 GLE/PIB

8 weeks

8-12 weeks(ii) Not recommended
SOF/LDV +/- RBV

12 weeks +/- RBV(viii)

12 weeks with RBV(iv)

12 weeks with RBV(ix)

SOF/VEL 12 weeks 12 weeks with RBV(ix)
For HCV treatment options to be used if preferred options are not available, please see version 10.1 of the EACS Guidelines

EBR = elbasvir
GLE = glecaprevir
GZR = grazoprevir
LDV = ledipasvir
PIB = pibrentasvir
RBV = ribavirin
SOF = sofosbuvir
VEL = velpatasvir
VOX = voxilaprevir
RAS = resistance associated substitutions

 
  1. In PLWH with GT1a with baseline HCV-RNA < 800,000 IU/mL and/or absence of NS5A RASs, as well as in treatment-naïve PLWH with GT4 with HCV-RNA < 800,000 IU/mL In GT 1b treatment-naïve PLWH with F0-F2 fibrosis 8 weeks can be considered
  2. 8 weeks treatment can be considered in treatment naïve PLWH
  3. 8 weeks treatment without RBV only in treatment-naïve PLWH with F < 3 and baseline HCV-RNA < 6 million IU/mL
  4. RBV can be omitted in treatment-naïve or -experienced PLWH with compensated cirrhosis without baseline NS5A RAS. In persons intolerant to RBV, treatment may be prolonged to 24 weeks
  5. Treatment duration in HCV GT3 who failed previous treatment with IFN and RBV +/- SOF or SOF and RBV should be 16 weeks
  6. In treatment experienced PLWH RBV should be added unless NS5A RASs are excluded; if these persons are intolerant to RBV, treatment may be prolonged to 24 weeks without RBV
  7. If RAS testing is available and demonstrates absence of NS5A RAS Y93H, RBV can be omitted in treatment naive PLWH with compensated cirrhosis
  8. In treatment experienced (exposure to IFN/RBV/SOF) PLWH add RBV treatment for 12 weeks or prolong treatment to 24 weeks without RBV
  9. In persons intolerant to RBV, treatment may be prolonged to 24 weeks