for Veterans and the Public
Chronic Hepatitis C Virus (HCV) Infection: Treatment Considerations
This revision (October 18, 2017) incorporates updates to treatment regimens for chronic hepatitis C virus (HCV) infection, genotypes 1-4, including re-treatment of patients who previously failed direct-acting antiviral therapy. New and updated sections include:
- Updated "Summary Table: Treatment Considerations and Choice of Regimen for HCV-Monoinfected and HIV/HCV-Coinfected Patients"
- A new table titled "HCV Direct-Acting Antiviral Agents by Drug Class" (Table 4 in PDF) (Online)
- Revisions to the "Interpretation of Resistance-Associated Substitutions" section
- Treatments for Genotype 1-Infected Patients, including Genotype 1-Infected Patients Who Have Failed DAA-Based Therapy
- Treatment of Chronic HCV Genotype 2
- Treatment of Chronic HCV Genotype 3, including Genotype 3-Infected Patients Who Have Failed NS5A-Based Therapy
- Treatment of Chronic HCV Genotype 4
- Revisions to tables showing drug-drug interactions to provide clinicians with guidance on the concomitant use of HCV drugs and other drugs, including HIV antiretroviral agents (Table 23 and Table 24).
The Panel continues to recommend:
- HIV/HCV-coinfected patients receive the same HCV antiviral regimens as HCV-monoinfected patients unless ledipasvir/sofosbuvir is being considered, in which case a 12-week regimen should be used (instead of an 8-week regimen).
- HBV testing and monitoring prior to starting HCV DAA. Details can be found in Appendix D.