HCV Genotypes and Traditional Regimens

Genotype 1

• Mavyret — first-line for 1a and 1b; 8 weeks

• Epclusa — first-line for 1a and 1b; 12 weeks

• Harvoni — first-line for 1a and 1b; 12 weeks (*some patients without cirrhosis [non-black, no HIV infection, HCV levels <6 million IU/mL] eligible for 8 weeks)

• Zepatier — alternative for 1a (*resistance testing needed regardless of cirrhosis status), first-line for 1b; 12 weeks

  • 1a cannot have NS5A inhibitor resistance!!!

Genotype 2

• Mavyret — first-line for 2; 8 weeks

  • Slightly lower recommendation quality in patients with compensated cirrhosis (as opposed to patients without cirrhosis)

• Epclusa — first-line for 2; 12 weeks

Genotype 3

• Mavyret — first -line for 3; 8 weeks

• Epclusa — first-line for 3 (*resistance testing needed if patient has compensated cirrhosis); 12 weeks

  • 3 + compensated cirrhosis (as opposed to no cirrhosis) cannot have NS5A resistance-associated mutation Y93H, which gives resistance to velpatasvir

• Vosevi — alternative regimen for 3 if patient has compensated cirrhosis; 12 weeks

  • The only time Vosevi is used in a treatment naive patient (instead of as salvage therapy for those who fail initial treatment)

Genotype 4

• Mavyret — first-line for 4; 8 weeks (*HIV co-infected patients with compensated cirrhosis for 12 weeks)

  • Better data than other treatment options for 4

• Epclusa — first-line for 4; 12 weeks

  • Better data than other treatment options for 4

• Harvoni — first-line for 4; 12 weeks

• Zepatier — first-line for 4; 12 weeks

Genotypes 5 and 6

• Mavyret — first-line for 5 and 6; 8 weeks

• Epclusa — first-line for 5 and 6; 12 weeks

• Harvoni — first-line for 5 and 6; 12 weeks

All patients being considered for treatment in HCV, for our purposes, must be…

Treatment-naive + [no cirrhosis OR compensated cirrhosis (Child-Pugh A)]