Hepatitis C: Treatment

Who can receive new treatment for hepatitis C?

European guidelines issued by the European Association for the Study of the Liver (ELPA) in 2016 recommend that anyone with liver damage or fibrosis stage 2 (moderate liver damage) or above should receive treatment without delay. In most European countries people with cirrhosis and genotypes 1, 3 or 4 are being given priority for treatment with newer interferon-free drug combinations, in order to prevent liver damage progressing further. At this time, in most countries people without moderate-to-severe liver damage and without evidence of fast progression of liver disease are less likely to receive treatment.

Treatment recommendations differ according to genotype. Some combinations of direct-acting antivirals are active against all, or several, HCV genotypes. These are called pan- genotypic drugs. Other direct-acting antivirals are only active against genotype 1.

The table below outlines European recommendations for the treatment of each genotype issued in September 2016. Access to these drugs varies between countries because of national differences in what form of treatment is funded by governments.

Glossary

association

When there is a statistical relationship between two variables. For example, when A increases, B increases. An association means that the two variables change together, but it doesn't necessarily mean that A causes B. The relationship isn't necessarily causal.

cirrhosis

Scarring of the liver – the structure of the liver is altered. See also ‘fibrosis’, which is moderate scarring. See also ‘compensated cirrhosis’ and ‘decompensated cirrhosis’.

compensated cirrhosis

The earlier stage of cirrhosis, during which the liver is damaged but still able to perform most of its functions. See also ‘cirrhosis’ and ‘decompensated cirrhosis’.

decompensated cirrhosis

The later stage of cirrhosis, during which the liver cannot perform some vital functions and complications occur. See also ‘cirrhosis’ and ‘compensated cirrhosis’.

fibrosis

Scarring of the liver – the development of hard, fibrous tissue. See also ‘cirrhosis’, which is more severe scarring.

genotype

A strain or subtype of a virus. For hepatitis C, genotypes are identified by a number (e.g. genotypes 1,2,3,4,5 and 6); some subtypes have also been identified (e.g. genotypes 1a and 1b). For hepatitis B, genotypes are identified by a letter (A to H). The genotype may influence the risk of disease progression for both viruses; some genotypes respond differently to some treatments.

interferon-free

A treatment regimen that does not include pegylated interferon.

stage

The stage of hepatitis infection refers to the amount of liver scarring (fibrosis) detected by biopsy. Usually measured on scales of 0 to 4, or 0 to 6 (higher numbers indicated more severe inflammation). 

treatment-experienced

A person who has previously taken treatment for a condition.

Genotype 1

 

Add ribavirin?

Duration

Duration if cirrhotic

Harvoni (sofosbuvir & ledipasvir)

If cirrhotic or treatment-experienced and genotype 1a

8-12 weeks

12 weeks (24 weeks without ribavirin)

Viekirax & Exviera

(ombitasvir, paritaprevir & dasabuvir)

If genotype 1a

12 weeks

12 weeks in genotype 1b, 24 weeks in genotype 1a

Epclusa (sofosbuvir & ledipasvir)

If decompensated cirrhosis

12 weeks

12 weeks

Zepatier (elbasvir & grazoprevir)

If viral load is high or baseline resistance to elbasvir in genotype 1a; extend treatment to 16 weeks when using ribavirin

12 weeks

12 weeks

Sofosbuvir (Sovaldi) & daclatasvir (Daklinza)

If cirrhotic and genotype 1a or post-transplant

12 weeks

12 weeks (24 weeks without ribavirin or if cirrhosis is decompensated)

Genotype 2

 

Add ribavirin?

Duration

Duration if cirrhotic

Sofosbuvir (Sovaldi) & daclatasvir (Daklinza)

If decompensated cirrhosis

12 weeks

12 weeks

Epclusa (sofosbuvir & velpatasvir)

No

12 weeks

12 weeks

Genotype 3

 

Add ribavirin?

Duration

Duration if cirrhotic

Sofosbuvir & velpatasvir (Epclusa)

If decompensated cirrhosis; consider also in compensated cirrhosis and treatment-experienced patients without cirrhosis

12 weeks (24 weeks in treatment-experienced)

12 weeks (24 weeks without ribavirin)

Sofosbuvir (Sovaldi)/daclatasvir (Daklinza)

If cirrhotic or treatment experienced

12 weeks

12 weeks treatment-experienced, 24 weeks cirrhotic

Genotype 4

 

Add ribavirin?

Duration

Duration if cirrhotic

Sofosbuvir & ledipasvir (Harvoni)

If cirrhotic or treatment experienced

12 weeks

12 weeks (24 weeks without ribavirin)

Ombitasvir/paritaprevir (Viekirax)

Yes

12 weeks

12 weeks

Sofosbuvir & velpatasvir (Epclusa)

If decompensated cirrhosis

12 weeks

12 weeks

Elbasvir & grazoprevir (Zepatier)

If viral load is high or baseline resistance to elbasvir; extend treatment to 16 weeks when using ribavirin

12 weeks

12 weeks

Sofosbuvir (Sovaldi) & simeprevir (Olysio)

If cirrhotic

12 weeks

12 weeks (24 weeks without ribavirin)

Sofosbuvir (Sovaldi) & daclatasvir (Daklinza)

If cirrhotic

12 weeks

12 weeks (24 weeks without ribavirin or if cirrhosis is decompensated)

Genotypes 5 & 6

 

Add ribavirin?

Duration

Duration if cirrhotic

Harvoni (sofosbuvir & ledipasvir)

If cirrhotic or treatment-experienced

12 weeks

12 weeks (24 weeks without ribavirin)

Epclusa (sofosbuvir & ledipasvir)

If decompensated cirrhosis

12 weeks

12 weeks

Sofosbuvir (Sovaldi) & daclatasvir (Daklinza)

If cirrhotic or treatment-experienced

12 weeks

12 weeks (24 weeks without ribavirin)

This information was originally adapted from Hepatitis C: Understanding a silent killer, published by the European Liver Patients Association. It was updated in 2016.