Hepatitis C: The Basics : My first round of HCV therapy didn't work. Will re-treatment be effective?
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My first round of HCV therapy didn't work. Will re-treatment be effective?

According to the FDA, there are three categories of treatment-experienced people who have completed therapy but are still living with HCV. They include:

Responder Relapser: A person with an undetectable HCV viral load at end of treatment with a peginterferon-based regimen, but who has a detectable viral load within 24 weeks after stopping treatment.

Partial Responder: A person who sees his or her HCV viral load decrease by at least 2 log (at least 99 percent) by week 12 of treatment but does not achieve an undetectable viral load at the end of treatment with peginterferon plus ribavirin.

Null Responder: A person who does not see his or her HCV viral load decrease by at least 2 log by week 12 of peginterferon/ribavirin treatment.

In addition, some people stop HCV treatment because of severe side effects, and others do not know their HCV treatment history.

Here are the recommendations for HCV re-treatment for all genotypes from the American Association for the Study of Liver Diseases (AASLD) and Infectious Diseases Society of America (IDSA). Note: In December 2014, AASLD and IDSA will announce new recommendations regarding the use of Harvoni (sofosbuvir + ledipasvir):

AASLD HCV Re-treatment Recommendations for PEG*/ribavirin nonresponder patients who are eligible to receive interferon
Recommended Alternative
Genotype 1 if prior treatment was without an HCV protease inhibitor Sovaldi + Olysio +/- ribavirin  for 12 weeks

Olysio for 12 weeks + ribavirin +  PEG* for 48 weeks

or

Sovaldi for 12 weeks + ribavirin + PEG* for 12-24 weeks

Genotype 1 if prior treatment was with an HCV protease inhibitorSovaldi for 12 weeks + ribavirin +  PEG* for 12-24 weeks none
Genotype 1 if prior treatment was  with/without an HCV protease inhibitorSovaldi for 12 weeks + ribavirin + PEG* for 12-24 weeksnone
Genotype 2 Sovaldi + ribavirin for 12 weeks** Sovaldi + ribavirin + PEG* for 12 weeks**
Genotype 3 Sovaldi + ribavirin for 24 weeks  Sovaldi + ribavirin + PEG* for 24 weeks
Genotype 4 Sovaldi + ribavirin + PEG* for 12 weeks Sovaldi + ribavirin for 24 weeks
Genotype 5 or 6 Sovaldi + ribavirin + PEG* for 12 weeks none


AASLD HCV Re-treatment Recommendations
for PEG*/ribavirin nonresponder patients who are
NOT eligible to receive interferon
Recommended Alternative
Genotype 1 if prior treatment was with/without an HCV protease inhibitor Sovaldi + ribavirin for 24 weeks none
Genotype 2 Sovaldi + ribavirin for 12 weeks**  none
Genotype 3 Sovaldi + ribavirin for 24 weeks none
Genotype 4 Sovaldi + ribavirin for 24 weeks none
Genotype 5 or 6 none none


* PEG = peginterferon
** Patients with cirrhosis may benefit by extension of treatment to 16 weeks.



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Last Revised: December 04, 2014

This content is written by the Hep editorial team.

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