State of the Art, Unresolved Issues, and Future Research Directions in the Fight against Hepatitis C Virus: Perspectives for Screening, Diagnostics of Resistances, and Immunization
Table 2
Recommended regimen for the treatment of HCV with direct-acting antivirals-based combination therapies.
Genotype
Presence of cirrhosis
Recommended regimen
Alternative regimen
Strength of recommendation
Quality of evidence
1a
Without cirrhosis
DCV + SOF (12 weeks) LDV + SOF (12 weeks)
SMV + SOF (12 weeks) OBV + PTV/r + DSV + R (12 weeks)
Strong
Moderate
With cirrhosis
DCV + SOF (24 weeks) DCV + SOF + R (12 weeks) LDV + SOF (24 weeks) LDV + SOF + R (12 weeks)
SMV + SOF (24 weeks) SMV + SOF + R (12 weeks) OBV + PTV/r + DSV + R (24 weeks)
1b
Without cirrhosis
DCV + SOF (12 weeks) LDV + SOF (12 weeks)
SMV + SOF (12 weeks) OBV + PTV/r + DSV (12 weeks)
Strong
Moderate
With cirrhosis
DCV + SOF (12 weeks) LDV + SOF (12 weeks)
SMV + SOF (24 weeks) SMV + SOF + R (12 weeks) OBV + PTV/r + DSV + R (12 weeks)
2
Without cirrhosis
SOF + R (12 weeks)
DCV + SOF (12 weeks)
Strong
Low
With cirrhosis
SOF + R (16 weeks)
DCV + SOF (12 weeks)
3
Without cirrhosis
DCV + SOF (12 weeks) SOF + R (24 weeks)
Strong
Low
With cirrhosis
DCV + SOF + R (24 weeks)
SOF + PegIFN + R (12 weeks)
4
Without cirrhosis
DCV + SOF (12 weeks) LDV + SOF (12 weeks)
SMV + SOF (12 weeks) OBV + PTV/r + R (12 weeks)
Strong
Moderate
With cirrhosis
DCV + SOF (24 weeks) DCV + SOF + R (12 weeks) LDV + SOF (24 weeks) LDV + SOF + R (12 weeks)
SMV + SOF (24 weeks) SMV + SOF + R (12 weeks) OBV + PTV/r + R (24 weeks)
5
Without cirrhosis
LDV + SOF (12 weeks)
SOF + PegIFN + R (12 weeks)
Conditional
Very Low
With cirrhosis
LDV + SOF (24 weeks) LDV + SOF + R (12 weeks)
SOF + PegIFN + R (12 weeks)
6
Without cirrhosis
LDV + SOF (12 weeks)
SOF + PegIFN + R (12 weeks)
Conditional
Very Low
With cirrhosis
LDV + SOF (24 weeks) LDV + SOF + R (12 weeks)
SOF + PegIFN + R (12 weeks)
DCV: daclatasvir; LDV: ledipasvir; SMV: simeprevir; SOF: sofosbuvir; OBV: ombitasvir; PTV: paritaprevir; DSV: dasabuvir; R: ribavirin; r: ritonavir; PegIFN: pegylated interferon. Treatment may be shortened to 8 weeks in treatment-naïve persons without cirrhosis if their baseline HCV RNA level is below 6 million (6.8 log) IU/mL. The duration of treatment should be shortened with caution. If platelet count <75 × 103/μL, then 24 weeks’ treatment with ribavirin should be given. If positive for the Q80K variant, a simeprevir/sofosbuvir regimen should not be chosen.
