Genotype 1
  • Daclatasvir (Daklinza™) + Sofosbuvir (Sovaldi®) ± ribavirin - no cirrhosis, cirrhosis (Child-Pugh A,B,C), and post-liver transplant
  • Epclusa® (sofosbuvir + velpatasvir) ± ribavirin - no cirrhosis and cirrhosis (Child-Pugh A,B,C)
  • Harvoni™ (sofosbuvir + ledipasvir) ± ribavirin - no cirrhosis, cirrhosis (Child-Pugh A,B,C), and post-liver transplant
  • Mavyret™ (glecaprevir + pibrentasvir) - no cirrhosis and Child-Pugh A
  • Simeprevir (Olysio®) + Sofosbuvir (Sovaldi®) - no cirrhosis and Child-Pugh A
  • Viekira Pak™ / Viekira XR™ (ombitasvir + paritaprevir + dasabuvir + ritonavir) - no cirrhosis, Child-Pugh A, and post-liver transplant
  • Vosevi™ (sofosbuvir + velpatasvir + voxilaprevir) - retreatment in no cirrhosis and Child-Pugh A
  • Zepatier™ (elbasvir + grazoprevir) - no cirrhosis and Child-Pugh A
Genotype 2
  • Epclusa® (sofosbuvir + velpatasvir) ± ribavirin - no cirrhosis and cirrhosis (Child-Pugh A,B,C)
  • Mavyret™ (glecaprevir + pibrentasvir) - no cirrhosis and Child-Pugh A
  • Sofosbuvir (Sovaldi®) + ribavirin - no cirrhosis and Child-Pugh A
  • Vosevi™ (sofosbuvir + velpatasvir + voxilaprevir) - retreatment in no cirrhosis and Child-Pugh A
Genotype 3
  • Daclatasvir (Daklinza™) + Sofosbuvir (Sovaldi®) ± ribavirin - no cirrhosis, cirrhosis (Child-Pugh A,B,C), and post-liver transplant
  • Epclusa® (sofosbuvir + velpatasvir) ± ribavirin - no cirrhosis and cirrhosis (Child-Pugh A,B,C)
  • Mavyret™ (glecaprevir + pibrentasvir) - no cirrhosis and Child-Pugh A
  • Sofosbuvir (Sovaldi®) + ribavirin - no cirrhosis and Child-Pugh A
  • Vosevi™ (sofosbuvir + velpatasvir + voxilaprevir) - retreatment in no cirrhosis and Child-Pugh A
Genotype 4
  • Epclusa® (sofosbuvir + velpatasvir) ± ribavirin - no cirrhosis and cirrhosis (Child-Pugh A,B,C)
  • Harvoni™ (sofosbuvir + ledipasvir) ± ribavirin - no cirrhosis, Child-Pugh A, and post-liver transplant
  • Mavyret™ (glecaprevir + pibrentasvir) - no cirrhosis and Child-Pugh A
  • Technivie™ (ombitasvir + paritaprevir + ritonavir) - no cirrhosis and Child-Pugh A
  • Zepatier™ (elbasvir + grazoprevir) - no cirrhosis and Child-Pugh A
  • Vosevi™ (sofosbuvir + velpatasvir + voxilaprevir) - retreatment in no cirrhosis and Child-Pugh A
Genotype 5
  • Epclusa® (sofosbuvir + velpatasvir) ± ribavirin - no cirrhosis and cirrhosis (Child-Pugh A,B,C)
  • Harvoni™ (sofosbuvir + ledipasvir) ± ribavirin - no cirrhosis and Child-Pugh A
  • Mavyret™ (glecaprevir + pibrentasvir) - no cirrhosis and Child-Pugh A
  • Vosevi™ (sofosbuvir + velpatasvir + voxilaprevir) - retreatment in no cirrhosis and Child-Pugh A
Genotype 6
  • Epclusa® (sofosbuvir + velpatasvir) ± ribavirin - no cirrhosis and cirrhosis (Child-Pugh A,B,C)
  • Harvoni™ (sofosbuvir + ledipasvir) ± ribavirin - no cirrhosis or Child-Pugh A
  • Mavyret™ (glecaprevir + pibrentasvir) - no cirrhosis and Child-Pugh A
  • Vosevi™ (sofosbuvir + velpatasvir + voxilaprevir) - retreatment in no cirrhosis and Child-Pugh A



Daklinza™ (Daclatasvir)
  • Dosage forms
    • 30 mg tablet
    • 60 mg tablet
  • Mechanism of action
  • FDA-approved indications / Dosing
    • HCV Genotype 1 (in combination with sofosbuvir ± ribavirin)
      • No cirrhosis or Child-Pugh A: Sofosbuvir 400 mg once daily + daclatasvir 60 mg once daily for 12 weeks
      • Child-Pugh B, C, or post-liver transplant: Sofosbuvir 400 mg once daily + daclatasvir 60 mg once daily + ribavirin for 12 weeks. Ribavirin should be started at 600 mg once daily and increased to 1000 mg/day as tolerated.
      • Genotype 1a with cirrhosis: Consider screening for the presence of NS5A polymorphisms. See daclatasvir for more.

    • HCV Genotype 3 (in combination with sofosbuvir ± ribavirin)
      • No cirrhosis: Sofosbuvir 400 mg once daily + daclatasvir 60 mg once daily for 12 weeks
      • Child-Pugh A Sofosbuvir 400 mg once daily + daclatasvir 60 mg once daily + ribavirin for 12 weeks. Ribavirin dosing should be weight-based.
      • Child-Pugh B, C, or post-liver transplant Sofosbuvir 400 mg once daily + daclatasvir 60 mg once daily + ribavirin for 12 weeks. Ribavirin should be started at 600 mg once daily and increased to 1000 mg/day as tolerated
  • Drug interactions
  • See Daclatasvir for a complete review
Epclusa® (sofosbuvir + velpatasvir)
  • Dosage forms
    • One tablet contains velpatasvir 100 mg and sofosbuvir 400 mg
  • Mechanism of action
  • FDA-approved indications / Dosing
    • HCV Genotype 1, 2, 3, 4, 5, and 6
      • Treatment-naïve and treatment-experienced with no cirrhosis or Child-Pugh A: Epclusa once daily for 12 weeks
      • Treatment-naïve and treatment-experienced with Child-Pugh B or C: Epclusa once daily + ribavirin for 12 weeks. Ribavirin dosing should be weight-based.
      • Previous treatment with regimens containing PegIFN/RBV with or without an HCV NS3/4A PI (boceprevir, simeprevir, or telaprevir)
  • Drug interactions
  • See Epclusa for a complete review
Harvoni™ (sofosbuvir + ledipasvir)
  • Dosage forms
    • One tablet contains ledipasvir 90 mg and sofosbuvir 400 mg
  • Mechanism of action
  • FDA-approved indications / Dosing
    • HCV Genotype 1 (adult dosing)
      • Treatment-naïve without cirrhosis, baseline viral load < 6 million IU/ml: May consider Harvoni once daily for 8 weeks
      • Treatment-naïve without cirrhosis or with Child-Pugh A: Harvoni once daily for 12 weeks
      • Treatment-experienced without cirrhosis: Harvoni once daily for 12 weeks
      • Treatment-experienced with Child-Pugh A: Harvoni once daily for 24 weeks
      • Treatment-naïve and treatment-experienced with Child-Pugh B or C: Harvoni once daily + ribavirin for 12 weeks. Ribavirin dosing should be weight-based with a starting dose of 600 mg and titration as tolerated.
      • Treatment-naïve and treatment-experienced post-liver transplant without cirrhosis or with Child-Pugh A: Harvoni once daily + ribavirin for 12 weeks. Ribavirin dosing should be weight-based.
      • Previous treatment with regimens containing PegIFN/RBV with or without an HCV NS3/4A protease inhibitor

    • HCV Genotype 4 (adult dosing)
      • Treatment-naïve and treatment-experienced without cirrhosis or with Child-Pugh A: Harvoni once daily for 12 weeks.
      • Treatment-naïve and treatment-experienced post-liver transplant without cirrhosis or with Child-Pugh A: Harvoni once daily + ribavirin for 12 weeks. Ribavirin dosing should be weight-based.
      • Previous treatment with regimens containing PegIFN/RBV with or without an HCV NS3/4A protease inhibitor

    • HCV Genotype 5 (adult dosing)
      • Treatment-naïve and treatment-experienced without cirrhosis or with Child-Pugh A: Harvoni once daily for 12 weeks
      • Previous treatment with regimens containing PegIFN/RBV with or without an HCV NS3/4A protease inhibitor

    • HCV Genotype 6 (adult dosing)
      • Treatment-naïve and treatment-experienced without cirrhosis or with Child-Pugh A: Harvoni once daily for 12 weeks
      • Previous treatment with regimens containing PegIFN/RBV with or without an HCV NS3/4A protease inhibitor
  • Drug interactions
  • See Harvoni for a complete review
Mavyret™ (glecaprevir + pibrentasvir)
  • Dosage forms
    • One tablet contains glecaprevir 100 mg and pibrentasvir 40 mg
  • Mechanism of action
  • FDA-approved indications / Dosing
    • Treatment-naïve patients - HCV Genotype 1, 2, 3, 4, 5, and 6
      • No cirrhosis: Three Mavyret tablets once daily with food for 8 weeks
      • Child-Pugh A: Three Mavyret tablets once daily with food for 12 weeks

    • Treatment-experienced patients

  • Mavyret is dosed 3 tablets once daily with food
  • PRS = Prior treatment with regimens containing interferon, pegylated interferon, ribavirin, and/or sofosbuvir
  • In trials, prior NS5A inhibitor treatment included ledipasvir and daclatasvir
  • In trials, prior NS3/4A PI treatment included simeprevir, boceprevir, or telaprevir
HCV GN Previous treatment No cirrhosis Child-Pugh A
1 An NS5A inhibitor without prior treatment with an NS3/4A protease inhibitor 16 weeks 16 weeks
1 An NS3/4A protease inhibitor without prior treatment with an NS5A inhibitor 12 weeks 12 weeks
1, 2, 4, 5, 6 PRS 8 weeks 12 weeks
3 PRS 16 weeks 16 weeks
  • Drug interactions
  • See Mavyret for a complete review
Olysio® (Simeprevir)
  • Dosage forms
    • 150 mg capsule
  • Mechanism of action
  • FDA-approved indications / Dosing
    • HCV Genotype 1 (in combination with sofosbuvir)
      • Treatment-naïve and treatment-experienced patients without cirrhosis: Sofosbuvir 400 mg once daily + simeprevir 150 mg once daily for 12 weeks
      • Treatment-naïve and treatment-experienced patients with Child-Pugh A: Sofosbuvir 400 mg once daily + simeprevir 150 mg once daily for 24 weeks
      • Prior treatment with interferon-based therapies
  • Drug interactions
  • See simeprevir for a complete review
Sovaldi® (Sofosbuvir)
  • Dosage forms
    • 400 mg tablet
  • Mechanism of action
  • FDA-approved indications / Dosing
    • HCV Genotype 1
    • HCV Genotype 2 (in combination with ribavirin)
      • Treatment-naïve and treatment-experienced without cirrhosis or with Child-Pugh A: Sofosbuvir 400 mg once daily + ribavirin for 12 weeks. Ribavirin dosing should be weight-based.
      • Previous treatment with interferon-based regimen with or without ribavirin
    • HCV Genotype 3 (in combination with ribavirin)
      • Treatment-naïve and treatment-experienced without cirrhosis or with Child-Pugh A: Sofosbuvir 400 mg once daily + ribavirin for 24 weeks. Ribavirin dosing should be weight-based.
      • Previous treatment with interferon-based regimen with or without ribavirin
  • Drug interactions
  • See sofosbuvir for a complete review
Technivie™ (ombitasvir + paritaprevir + ritonavir)
  • Dosage forms
    • Each Technivie tablet contains ombitasvir 12.5 mg, paritaprevir 75 mg, and ritonavir 50 mg
  • Dosing
    • Two Technivie tablets once daily in the morning with food
  • Mechanism of action
    • Ombitasvir is a NS5A inhibitor
    • Paritaprevir is a NS3/4A protease inhibitor
    • Ritonavir has no activity against HCV. It is added to the formulation to inhibit paritaprevir metabolism.
    • HCV drug MOA illustration
  • FDA-approved indications / Dosing
    • HCV Genotype 4 (in combination with ribavirin)
      • Without cirrhosis or with Child-Pugh A: Technivie + ribavirin for 12 weeks. Ribavirin dosing should be weight-based.
      • Treatment-naïve patients without cirrhosis may consider Technivie for 12 weeks without ribavirin
  • Drug interactions
  • See Technivie for a complete review
Viekira Pak™/Viekira XR™ (ombitasvir + paritaprevir + dasabuvir + ritonavir)
  • Dosage forms / Dosing
    • Viekira Pak
      • Viekira Pak comes with two tablets:
        • OPR tablet: ombitasvir 12.5 mg, paritaprevir 75 mg, ritonavir 50 mg
        • Dasabuvir tablet: dasabuvir 250 mg
      • Dosing: Take two OPR tablets once daily in the morning with a meal. Take one dasabuvir tablet twice a day with a meal.
    • Viekira XR
      • Each Viekira XR tablet contains dasabuvir 200 mg, ombitasvir 8.33 mg, paritaprevir 50 mg, and ritonavir 33.33 mg
      • Dosing: Take three tablets once daily with a meal
  • Mechanism of action
    • Ombitasvir is a NS5A inhibitor
    • Paritaprevir is a NS3/4A protease inhibitor
    • Dasabuvir is a NS5B polymerase inhibitor
    • Ritonavir has no activity against HCV. It is added to the formulation to inhibit paritaprevir metabolism.
    • HCV drug MOA illustration
  • FDA-approved indications
    • HCV Genotype 1a (in combination with ribavirin)
      • Treatment-naïve or interferon-experienced without cirrhosis: Viekira Pak/XR + ribavirin for 12 weeks. Ribavirin dosing should be weight-based.
      • Treatment-naïve or interferon-experienced with Child-Pugh A: Viekira Pak/XR + ribavirin for 24 weeks. Ribavirin dosing should be weight-based. For treatment-naïve patients, 12 weeks of therapy may be considered.
      • Post-liver transplant (Metavir ≤ 2): Viekira Pak/XR + ribavirin for 24 weeks. Ribavirin dosing should be weight-based.
    • HCV Genotype 1b
      • Treatment-naïve or interferon-experienced without cirrhosis and Child-Pugh A: Viekira Pak/XR for 12 weeks
      • Post-liver transplant (Metavir ≤ 2): Viekira Pak/XR + ribavirin for 24 weeks. Ribavirin dosing should be weight-based.
  • Drug interactions
  • See Viekira Pak/XR for a complete review
Vosevi™ (sofosbuvir + velpatasvir + voxilaprevir)
  • Dosage forms
    • One tablet contains sofosbuvir 400 mg, velpatasvir 100 mg, and voxilaprevir 100 mg
  • Dosing
    • One tablet once daily with food
  • Mechanism of action
    • Velpatasvir is a NS5A inhibitor
    • Sofosbuvir is a NS5B polymerase inhibitor
    • Voxilaprevir is a NS3/4A protease inhibitor
    • HCV drug MOA illustration
  • FDA-approved indications
    • Vosevi is approved for the retreatment of HCV in patients without cirrhosis or with Child-Pugh A who meet the following criteria:
      • HCV genotypes 1, 2, 3, 4, 5, and 6 in patients previously treated with an HCV regimen containing an NS5A inhibitor
      • HCV genotypes 1a or 3 in patients previously treated with an HCV regimen containing sofosbuvir without an NS5A inhibitor
      • NS5A inhibitors include the following drugs:
        • Daclatasvir
        • Elbasvir
        • Ledipasvir
        • Ombitasvir
        • Pibrentasvir
        • Velpatasvir
  • Drug interactions
  • See Vosevi for a complete review
Zepatier™ (elbasvir + grazoprevir)
  • Dosage forms
    • One tablet contains elbasvir 50 mg and grazoprevir 100 mg
  • Dosing
    • One tablet once daily with or without food
  • Mechanism of action
  • FDA-approved indications
  • NS5A polymorphisms affect response to Zepatier. See Zepatier for more.
  • PI = boceprevir, simeprevir, or telaprevir
  • Ribavirin dosing is weight-based (regimen 2)
Patient Treatment Duration
GT 1a: Treatment-naïve or PegIFN / RBV-experienced without baseline NS5A polymorphisms Zepatier 12 weeks
GT 1a: Treatment-naïve or PegIFN / RBV-experienced with baseline NS5A polymorphisms Zepatier + RBV 16 weeks
GT 1b: Treatment-naïve or PegIFN / RBV-experienced Zepatier 12 weeks
GT 1a or 1b: PegIFN / RBV / PI-experienced Zepatier + RBV 12 weeks
GT 4: Treatment-naïve Zepatier 12 weeks
GT 4: PegIFN / RBV-experienced Zepatier + RBV 16 weeks









Reference [2]
Highest Priority for treatment owing to highest risk for severe complications
Advanced fibrosis (Metavir F3) or compensated cirrhosis (Metavir F4)
Liver transplant recipients or patients awaiting transplant
Type 2 or 3 essential mixed cryoglobulinemia with end-organ manifestations (eg, vasculitis)
Proteinuria, nephrotic syndrome, or membranoproliferative glomerulonephritis

Reference [2]
High priority for treatment owing to high risk for complications
Fibrosis (Metavir F2)
HIV coinfection
Hepatitis B coinfection
Other coexistent liver disease (eg, NASH)
Debilitating fatigue
Type 2 diabetes
Porphyria cutanea tarda

Reference [2]
High Hepatitis C transmission risk
HIV-infected men who have sex with men
IV drug abusers
Incarcerated persons
Persons on long-term hemodialysis









Child-Pugh Score
Finding 1 2 3
Encephalopathy
(see encephalopathy staging below)
None 1 and 2 3 and 4
Ascites Absent Slight Moderate
Bilirubin(mg/dl) < 2 2 - 3 > 3
Albumin (g/dl) > 3.5 2.8 - 3.5 < 2.8
Prothrombin time (PT)
(seconds prolonged)

OR
< 4 4 - 6 > 6
INR < 1.7 1.7 - 2.3 > 2.3


Bilirubin (mg/dl) Child-Pugh score
< 4 1
4 - 10 2
> 10 3

  • Reference [5]
  • Surgical mortality based on 12-year study published in 1997 involving abdominal surgery [8]
TOTAL SCORE CHILD-PUGH CLASS EXPECTED MORTALITY
5 - 6 A 5-year survival 90%
Surgical mortality 10%
7 - 9 B 5-year survival 80%
Surgical mortality 32%
≥ 10 C More than 33% die within one year
Surgical mortality 82%

    Reference [6,7]
    Stage Mental status Neuro exam EEG findings
    0 normal normal none
    1 mild confusion sleep disturbance slight tremor normal to slightly normal
    2 disoriented abnormal behavior significant tremor coordination problems abnormal
    3 confused, incoherent excessive sleep muscle rigidity positive Babinski abnormal
    4 coma none abnormal



    Reference [9]
    Metavir fibrosis
    score (F)
    Finding
    0 No scarring
    1 Minimal scarring
    2 Scarring has occurred and extends outside the areas in the liver that contains blood vessels
    3 Bridging fibrosis is spreading and connecting to other areas that contain fibrosis
    4 Cirrhosis or advanced scarring of the liver

    Reference [9]
    Metavir activity
    score (A)
    Finding
    0 No activity
    1 Mild activity
    2 Moderate activity
    3 Severe activity