Viral hepatitis: A narrative review of hepatitis A–E

Table 4 DAA therapy for chronic hepatitis C virus

Regimen	Patient population	Duration (wk)
Genotype 1
Daclatasvir + sofosbuvir	Decompensated cirrhosis regardless of subtype	12
	HIV/HCV coinfection when antiretroviral regimen cannot be made to accommodate recommended regimens	12
Elbasvir/grazoprevir	Treatment naive or Peg/RBV experienced regardless of cirrhosis	12
	Severe renal impairment (CKD stage 4/5)	12
	Not for decompensated cirrhosis or post liver transplant with cirrhosis
Glecaprevir/pibrentasvir	Treatment naive or Peg/RBV experienced without cirrhosis	8
	Treatment naive or Peg/RBV experienced with cirrhosis, and non-NS5A failures (including NS3) regardless of cirrhosis	12
	Post liver transplant without cirrhosis	12
	Severe renal impairment (CKD stage 4 or 5)	8–12
	Post kidney transplant regardless of cirrhosis	12
	Not for decompensated cirrhosis or post liver transplant with cirrhosis
Ledipasvir/sofosbuvir	Treatment naive regardless of cirrhosis	12
	Treatment naive, no cirrhosis, non-black, HIV negative, and HCV RNA <106 IU/mL	8
	Peg/RBV (± NS3 protease inhibitor) experienced without cirrhosis	12
	Decompensated cirrhosis, treatment naive or Peg/RBV (± NS3 protease inhibitor) experienced	12
	Decompensated cirrhosis, prior sofosbuvir failure only	24
	Post liver transplant regardless of cirrhosis or decompensation	12
	Post kidney transplant regardless of cirrhosis	12
Sofosbuvir/velpatasvir	Treatment naive or Peg/RBV ± NS3 protease inhibitor experienced regardless of cirrhosis	12
	GT1b, non-NS5A DAA experienced regardless of cirrhosis	12
	Decompensated cirrhosis, treatment naive or Peg/RBV (± NS3 protease inhibitor) experienced	12
	Decompensated cirrhosis, DAA failure (including NS5A)b	24
Sofosbuvir/velpatasvir/voxilaprevir	NS5A failures (including NS3 protease inhibitor) regardless of cirrhosis	12
	GT1a, non-NS5A failures (including NS3 protease inhibitors) regardless of cirrhosis	12
	Not for decompensated cirrhosis or post liver transplant with cirrhosis
Genotype 2
Daclatasvir + sofosbuvir	Decompensated cirrhosis	12
	Post liver transplant regardless of cirrhosis or decompensation	12
Glecaprevir/pibrentasvir	Treatment naive or Peg/RBV experienced without cirrhosis	8
	Treatment naive or Peg/RBV experienced with cirrhosis, and sofosbuvir failures regardless of cirrhosis	12
	Post liver transplant without cirrhosis	12
	Severe renal impairment (CKD stage 4 or 5)	8–12
	Post kidney transplant regardless of cirrhosis	12
	Not for decompensated cirrhosis or post liver transplant with cirrhosis
Sofosbuvir/velpatasvir	Treatment naive, or Peg/RBV or non-NS5A experienced regardless of cirrhosis	12
	Decompensated cirrhosis, treatment naive or Peg/RBV or non-NS5A experienced	12
	Decompensated cirrhosis, DAA failure (including sofosbuvir ± NS5A)b	24
	Post liver transplant with decompensated cirrhosis	12
Sofosbuvir/velpatasvir/voxilaprevir	NS5A failures	12
	Not for decompensated cirrhosis or post liver transplant with cirrhosis
Genotype 3
Daclatasvir + sofosbuvir	Decompensated cirrhosis	12
	Post liver transplant regardless of cirrhosis or decompensation	12
Glecaprevir/pibrentasvir	Treatment naive without cirrhosis	8
	Treatment naive with compensated cirrhosis	12
	Post liver transplant without cirrhosis	12
	Severe renal impairment (CKD stage 4 or 5)	8–12
	Post kidney transplant regardless of cirrhosis	12
	Not for decompensated cirrhosis or post liver transplant with cirrhosis
Sofosbuvir + elbasvir/grazoprevir	Peg/RBV experienced with compensated cirrhosis	12
	Not for decompensated cirrhosis or post liver transplant with cirrhosis
Sofosbuvir/velpatasvir	Treatment naive without cirrhosis	12
	Treatment naive with cirrhosis or Peg/RBV experienced without cirrhosis	12
	Decompensated cirrhosis, treatment naive or Peg/ RBV experienced	12
	Decompensated cirrhosis, previously exposed to DAA (including sofosbuvir ± NS5A)b	24
	Post liver transplant with decompensated cirrhosis	12
Sofosbuvir/velpatasvir/voxilaprevir	Peg/RBV experienced with cirrhosis, or DAA failure (including NS5A inhibitors) regardless of cirrhosis	12
	Not for decompensated cirrhosis or post liver transplant with cirrhosis
Genotype 4
Daclatasvir + sofosbuvir	Decompensated cirrhosis	12
	HIV/HCV coinfection when antiretroviral regimen cannot be made to accommodate recommended regimens	12
Elbasvir/grazoprevir	Treatment naive or Peg/RBV experienced with prior relapse, regardless of cirrhosis	12
	Severe renal impairment (CKD stage 4/5)	12
	Not for decompensated cirrhosis or post liver transplant with cirrhosis
Glecaprevir/pibrentasvir	Treatment naive or Peg/RBV experienced without cirrhosis	8
	Treatment naive or Peg/RBV experienced with cirrhosis	12
	Post liver transplant without cirrhosis	12
	Severe renal impairment (CKD stage 4 or 5)	8–12
	Post kidney transplant regardless of cirrhosis	12
	Not for decompensated cirrhosis or post liver transplant with cirrhosis
	Treatment naive regardless of cirrhosis or Peg/RBV experienced without cirrhosis	12
	Decompensated cirrhosis, treatment naive or Peg/ RBV experienced	12
	Decompensated cirrhosis, sofosbuvir failure	24
	Post liver transplant regardless of cirrhosis or decompensation	12
	Post kidney transplant regardless of cirrhosis	12
Sofosbuvir/velpatasvir	Treatment naive or Peg/RBV experienced regardless of cirrhosis	12
	Decompensated cirrhosis, treatment naive or Peg/ RBV (± NS3 protease inhibitor) experienced	12
	Decompensated cirrhosis, DAA failure (including NS5A)	24
Sofosbuvir/velpatasvir/voxilaprevir	NS5A failures (including NS3 protease inhibitors) regardless of cirrhosis	12
	Not for decompensated cirrhosis or post liver transplant with cirrhosis
Sofusbuvir/ledipasvir	Treatment naive, compensated cirrhosis – not for decompensated cirrhosis	12
Genotype 5 or 6
Glecaprevir/pibrentasvir	Treatment naive or Peg/RBV experienced without cirrhosis	8
	Treatment naive or Peg/RBV experienced with cirrhosis	12
	Post liver transplant without cirrhosis	12
	Severe renal impairment (CKD stage 4 or 5)	8–12
	Post kidney transplant regardless of cirrhosis	12
	Not for decompensated cirrhosis or post liver transplant with cirrhosis
Ledipasvir/sofosbuvir	Treatment naive or Peg/RBV experienced regardless of cirrhosis	12
	Decompensated cirrhosis, treatment naive or Peg/ RBV experienced	12
	Decompensated cirrhosis, sofosbuvir failure	24
	Post liver transplant regardless of cirrhosis or decompensation	12
Sofosbuvir/velpatasvir	Treatment naive or Peg/RBV experienced regardless of cirrhosis	12
	Decompensated cirrhosis, treatment naive or Peg/RBV (± NS3 protease inhibitor) experienced	12
	Decompensated cirrhosis, DAA failure (including NS5A)	24
Sofosbuvir/velpatasvir/voxilaprevir	NS5A failures (including NS3 protease inhibitors) regardless of cirrhosis	12
	Not for decompensated cirrhosis or post liver transplant with cirrhosis

Adapted from American Association for the Study of Liver Diseases/IDSA guidelines (https://www.hcvguidelines.org/). CKD: Chronic kidney disease; DAA: Direct-acting antiviral; HIV: Human immunodeficiency virus; HCV: Hepatitis C virus; RBV: Ribavirin; Peg: Pegylated interferon.