If you have been treated for hepatitis C before, here are the recommendations for re-treatment for all genotypes from the American Association for the Study of Liver Diseases (AASLD) and Infectious Diseases Society of America (IDSA).

Note: Vosevi was recently approved by the FDA to treat genotypes 1 through 6 in adults without cirrhosis or with compensated cirrhosis, and who have previously been treated with an HCV regimen containing an NS5A inhibitor, or have genotype 1a or 3 infection and have previously been treated with an HCV regimen containing sofosbuvir without an NS5A inhibitor. Vosevi has not yet been reviewed for inclusion in the AASLD/IDSA list of recommended HCV treatments, but is included in this table. 

Mavyret was recently approved by the FDA to treat genotypes 1 through 6 in adults without cirrhosis or with compensated cirrhosis. It was also approved to retreat adults with genotypes 1 without cirrhosis or with compensated cirrhosis.who have previously been treated with an HCV regimen containing an NS5A inhibitor without prior treatment with an NS3/4A protease inhibitor or NS5A inhibitorAlthough not officially approved to retreat other genotypes, Mavyret’s product information provides details from clinical trials regarding retreatment of genotypes 2 through 6. Mavyret has not yet been reviewed for inclusion in the AASLD/IDSA list of recommended HCV treatments, but is included in this table. 


AASLD HCV Re-treatment Recommendations* for People Who Failed Prior Peginterferon and Ribavirin Treatment without Decompensated Cirrhosis or Certain Co-existing Medical Conditions, such as HCV Recurrence Post-Liver Transplant:


Genotype 1a

no cirrhosis

Recommended
  • Daklinza + Sovaldi for 12 weeks
  • Epclusa for 12 weeks
  • Harvoni for 12 weeks
  • Mavyret for 8 weeks
  • Olysio + Sovaldi for 12 weeks
  • Viekira + ribavirin for 12 weeks
  • Vosevi for 12 weeks
  • Zepatier for 12 weeks (without baseline NS5A RASs**)
Alternative
  • Zepatier + ribavirin for 16 weeks (with baseline NS5A RAVs**)

Genotype 1a

compensated cirrhosis

Recommended
  • Epclusa for 12 weeks
  • Harvoni + ribavirin for 12 weeks
  • Mavyret for 12 weeks
  • Vosevi for 12 weeks
  • Zepatier for 12 weeks (without baseline NS5A RAVs**)
Alternative
  • Daklinza + Sovaldi with/without ribavirin for 24 weeks
  • Havroni for 24 weeks
  • Olysio + Sovaldi with/without ribavirin for 24 weeks (without Q80K RAVs**)
  • Viekira + ribavirin for 24 weeks
  • Zepatier + ribavirin for 16 weeks (with baseline NS5A RAVs**)

Genotype 1b

no cirrhosis

Recommended
  • Daklinza + Sovaldi for 12 weeks
  • Epclusa for 12 weeks
  • Harvoni for 12 weeks
  • Mavyret for 8 weeks
  • Olysio + Sovaldi for 12 weeks
  • Viekira for 12 weeks
  • Vosevi for 12 weeks
  • Zepatier for 12 weeks
Alternativen/a

Genotype 1b

compensated cirrhosis

Recommended
  • Epclusa for 12 weeks
  • Harvoni + ribavirin for 12 weeks
  • Mavyret for 12 weeks
  • Viekira for 12 weeks
  • Vosevi for 12 weeks
  • Zepatier for 12 weeks
Alternative
  • Daklinza + Sovaldi with/without ribavirin for 24 weeks 
  • Harvoni for 24 weeks
  • Olysio + Sovaldi with/without ribavirin for 24 weeks

Genotype 2

no cirrhosis

Recommended
  • Epclusa for 12 weeks
  • Mavyret for 8 weeks
  • Vosevi for 12 weeks
Alternative
  • Daklinza + Sovaldi for 12 weeks

Geontype 2

compensated cirrhosis

Recommended
  • Epclusa for 12 weeks
  • Mavyret for 8 weeks
  • Vosevi for 12 weeks
Alternative
  • Daklinza + Sovaldi for 16 to 24 weeks

Genotype 3

no cirrhosis

Recommended
  • Daklinza + Sovaldi for 12 weeks
  • Epclusa for 12 weeks
  • Mavyret for 16 weeks
  • Vosevi for 12 weeks
Alternative

Geontype 3

compensated cirrhosis

Recommended
  • Epclusa for 12 weeks
  • Mavyret for 16 weeks
  • Vosevi for 12 weeks
  • Zepatier + Sovaldi for 12 weeks
Alternative

Daklinza + Sovaldi + ribavirin for 24 weeks

Genotype 4

no cirrhosis

Recommended
  • Epclusa for 12 weeks
  • Harvoni for 12 weeks
  • Mavyret for 8 weeks
  • Technivie + ribavirin for 12 weeks
  • Vosevi for 12 weeks
  • Zepatier for 12 weeks; Zepatier + ribavirin for 16 weeks if prior treatment failed to suppress HCV
Alternative

    Geontype 4

    compensated cirrhosis

    Recommended
    • Epclusa for 12 weeks
    • Harvoni + ribavirin for 12 weeks
    • Harvoni for 24 weeks
    • Mavyret for 12 weeks
    • Technivie + ribarivin for 12 weeks
    • Vosevi for 12 weeks
    • Zepatier for 12 weeks; Zepatier + ribavirin for 16 weeks if prior treatment failed to suppress HCV
    Alternative

    Genotype 5

    no cirrhosis

    Recommended
    • Epclusa for 12 weeks
    • Harvoni for 12 weeks
    • Mavyret for 8 weeks
    • Vosevi for 12 weeks
    Alternative

    Genotype 5

    compensated cirrhosis

    Recommended
    • Epclusa for 12 weeks
    • Harvoni for 12 weeks
    • Mavyret for 12 weeks
    • Vosevi for 12 weeks
    Alternative

    Genotype 6

    no cirrhosis

    Recommended
    • Epclusa for 12 weeks
    • Harvoni for 12 weeks
    • Mavyret for 8 weeks
    • Vosevi for 12 weeks
    Alternative

    Genotype 6

    compensated cirrhosis

    Recommended
    • Epclusa for 12 weeks
    • Harvoni for 12 weeks
    • Mavyret for 12 weeks
    • Vosevi for 12 weeks
    Alternative

    * When more than one treatment is recommended, medications are listed alphabetically

    **RASs = resistance-associated  substitutions (formerly RAVs or resistance-associated variants) 

    AASLD HCV Re-treatment Recommendations* for People Who Failed Prior Treatment with Sovaldi (sofosbuvir) + Ribavirin, with/without Peginterferon:


    Genotype 1

    no cirrhosis

    Recommended
    • Harvoni + ribavirin for 12 weeks
    • Mavyret for 8 weeks
    • Vosevi for 12 weeks
    Alternative

    Genotype 1

    compensated cirrhosis

    Recommended
    • Harvoni + ribavirin for 24 weeks
    • Mavyret for 12 weeks
    • Vosevi for 12 weeks
    Alternative

    Genotype 2

    no cirrhosis

    Recommended
    • Epclusa for 12 weeks
    • Mavyret for 8 weeks
    • Vosevi for 12 weeks
    Alternative
    • Daklinza + Sovaldi with/without ribavirin for 24 weeks

    Genotype 2

    compensated cirrhosis

    Recommended
    • Epclusa for 12 weeks
    • Mavyret for 12 weeks
    • Vosevi for 12 weeks
    Alternative

    Genotype 3

    with/without cirrhosis

    Recommended
    • Daklinza + Sovaldi with ribavirin for 24 weeks
    • Epclusa + ribavirin for 12 weeks
    • Mavyret for 16 weeks
    • Vosevi for 12 weeks
    Alternative

    Genotype 4

    no cirrhosis

    Recommended

    • Mavyret for 8 weeks
    • Vosevi for 12 weeks
    Alternative

    Genotype 4

    compensated cirrhosis

    Recommended

    • Mavyret for 12 weeks
    Alternative

    Genotype 5 or 6

    no cirrhosis

    Recommended

    • Mavyret for 8 weeks
    Alternative

    Genotype 5 or 6

    compensated cirrhosis

    Recommended

    • Mavyret for 12 weeks
    Alternative

    * When more than one treatment is recommended, medications are listed alphabetically

    AASLD HCV Re-treatment Recommendations* for People Who Failed Prior Treatment with Peginterferon, Ribavirin, and an HCV Protease Inhibitor (Incivek, Olysio, Victrelis):


    Genotype 1

    no cirrhosis

    Recommended
    • Daklinza + Sovaldi for 12 weeks
    • Epclusa for 12 weeks
    • Harvoni for 12 weeks
    • Mavyret for 12 weeks
    • Vosevi for 12 weeks
    • Zepatier + ribavirin for 12 weeks; 16 weeks for genotype 1a with baseline NS5A RAVs**
    Alternative

    Genotype 1

    compensated cirrhosis

    Recommended
    • Daklinza + Sovaldi with/without ribavirin for 24 weeks
    • Epclusa for 12 weeks
    • Harvoni + ribavirin for 12 weeks
    • Harvoni for 24 weeks
    • Mavyret for 12 weeks
    • Vosevi for 12 weeks
    • Zepatier + ribavirin for 12 weeks; 16 weeks for genotype 1a with baseline NS5A RAVs**
    Alternative

    * When more than one treatment is recommended, medications are listed alphabetically

    ** RASs = resistance-associated  substitutions (formerly RAVs or resistance-associated variants) 

    FDA Approved Re-treatment for People Who Failed Prior Treatment With an NS5A inhibitor (In clinical trials, subjects were treated with prior regimens using daclatasvir, elbasvir, ledipasvir, ombitasvir, or velpatasvir.):


    Genotype 1-6

    no cirrhosis or

    compensated cirrhosis

    Recommended
    • Vosevi for 12 weeks
    Alternative

    FDA Approved Re-treatment for People Who Failed Prior Treatment With Sofosbuvir Without an NS5A Inhibitor (In clinical trials, subjects were treated with prior regimens using sofosbuvir with or without any of the following: peginterferon alfa/ribavirin, ribavirin, HCV NS3/4A protease inhibitor such as boceprevir, simeprevir or telaprevir.):


    Genotype 1a or 3

    no cirrhosis or

    compensated cirrhosis

    Recommended
    • Vosevi for 12 weeks
    Alternative

    FDA Approved Re-treatment for People Who Failed Prior Treatment With an NS5A inhibitor but Not an NS3/4A Protease Inhibitor (In clinical trials, subjects were treated with prior regimens containing Harvoni or Daklinza with pegylated interferon and ribavirin):


    Genotype 1

    no cirrhosis or

    compensated cirrhosis

    Recommended
    • Mavyret for 16 weeks
    Alternative

    FDA Approved Re-treatment for People Who Failed Prior Treatment With an NS3/4A Protease inhibitor but Not an NS5A Inhibitor (In clinical trials, subjects were treated with prior regimens containing simeprevir and sofosbuvir, or simeprevir, boceprevir, or telaprevir with pegylated interferon and ribavirin):


    Genotype 1

    no cirrhosis or

    compensated cirrhosis

    Recommended
    • Mavyret for 12 weeks
    Alternative

    AASLD HCV Re-treatment Recommendations* for People Who Failed Prior Treatment with Olysio + Sovaldi or an HCV NS5A Inhibitor (See list of Hepatitis C Medications):


    Genotype 1

    no cirrhosis

    Recommended
    • Deferral of treatment is recommended and do not have reasons for urgent treatment.
    Alternative

    Genotype 1

    with cirrhosis

    Recommended
    • Test for RAVs and treat accordingly
    • When using nucleotide-based (eg, Sovaldi) dual DAA therapy, use ribavirin (if tolerated) and treat for 24 weeks
    • If available, nucleotide-based (eg, sofosbuvir) triple or quadruple DAA regimens may be considered; use ribavirin (if tolerated) and treat for 12 to 24 weeks
    Alternative

    * When more than one treatment is recommended, medications are listed alphabetically

    Medications that are NOT recommended for HCV treatment:

    • Sovaldi + ribavirin for 24 weeks
    • Peginterferon/ribavirin with or without Incivek, Olysio, Sovaldi, or Victrelis 
    • Monotherapy with peginterferon, ribavirin or a direct-acting antiviral

    For those needing information about medication for advanced liver disease, visit HCV treatment recommendations for those with decompenstated cirrhosis. Click on HCV Treatment Post-Transplantation for information about HCV recurrence following liver transplantation. 

    Last Revised: August 7, 2017