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).


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

Genotype 1a

compensated cirrhosis

Recommended
  • Epclusa for 12 weeks
  • Zepatier for 12 weeks (without baseline NS5A RASs**
  • Mavyret for 12 weeks
Alternative
  • Harvoni + ribavirin for 12 weeks
  • Zepatier + ribavirin for 16 weeks (with baseline NS5A RASs**)

Genotype 1b

no cirrhosis

Recommended
  • Epclusa for 12 weeks
  • Harvoni for 12 weeks
  • Mavyret for 8 weeks
  • Zepatier for 12 weeks
Alternative
  • Olysio + Sovaldi for 12 weeks
  • Viekira XR for 12 weeks
  • Daklinza + Sovaldi for 12 weeks

Genotype 1b

compensated cirrhosis

Recommended
  • Epclusa for 12 weeks 
  • Zepatier for 12 weeks
  • Mavyret for 12 weeks
Alternative
  • Harvoni + ribavirin for 12 weeks
  • Viekira XR for 12 weeks

Genotype 2

no cirrhosis

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

Geontype 2

compensated cirrhosis

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

Genotype 3

no cirrhosis

Recommended
  • Epclusa for 12 weeks
Alternative
  • Daklinza + Sovaldi for 12 weeks
  • Mavyret for 16 weeks
  • Vosevi for 12 weeks (with Y93H RASs**) 

Geontype 3

compensated cirrhosis

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

Genotype 4

no cirrhosis

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

    Geontype 4

    compensated cirrhosis

    Recommended
    • Epclusa for 12 weeks
    • Mavyret for 12 weeks
    • Zepatier for 12 weeks for responder-relapsers to prior treatment
    Alternative
    • Technivie + ribarivin for 12 weeks
    • Harvoni + ribavirin for 12 weeks
    • Zepatier + ribavirin for 16 weeks if prior treatment failed to suppress HCV

    Genotype 5

    no cirrhosis

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

    Genotype 5

    compensated cirrhosis

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

    Genotype 6

    no cirrhosis

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

    Genotype 6

    compensated cirrhosis

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

    *Medications are listed by evidence level as determined by HCVGuidelines.org, then alphabetically.  

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

    AASLD HCV Re-treatment Recommendations* for People Who Failed Prior Treatment with Peginterferon, Ribavirin, and an HCV NS3 Protease Inhibitor (Incivek, Olysio, Victrelis):


    Genotype 1

    no cirrhosis

    Recommended
    • Epclusa for 12 weeks
    • Harvoni for 12 weeks
    • Mavyret for 12 weeks
    Alternative
    • Zepatier + ribavirin for 12 weeks for genotype 1b and genotype 1a without baseline NS5A RASs**;16 weeks for genotype 1a with baseline NS5A RASs**

    Genotype 1

    compensated cirrhosis

    Recommended
    • Epclusa for 12 weeks
    • Mavyret for 12 weeks
    Alternative
    • Harvoni + ribavirin for 12 weeks
    • Zepatier + ribavirin for 12 weeks for genotype 1b and genotype 1a without baseline NS5A RASs**;16 weeks for genotype 1a with baseline NS5A RASs**

    *Medications are listed by evidence level as determined by HCVGuidelines.org, then alphabetically.  

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

    AASLD HCV Re-treatment Recommendations* for People Who Failed Prior Non-NS5A Inhibitor Treatment Containing Sovaldi:


    Genotype 1

    no cirrhosis

    Recommended
    • Vosevi for 12 weeks
    • Epclusa for 12 weeks
    • Mavyret for 12 weeks
    Alternative
    • Harvoni + ribavirin for 12 weeks (except when previously failed Olysio treatment)

    Genotype 1

    compensated cirrhosis

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

    Genotype 2

    no cirrhosis

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

    Genotype 2

    compensated cirrhosis

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

    Genotype 3

    no cirrhosis

    Recommended
    • Vosevi for 12 weeks
    Alternative

    Genotype 3

    compensated cirrhosis

    Recommended
    • Vosevi + ribavirin for 12 weeks
    Alternative

    Genotype 4

    no cirrhosis

    Recommended
    • 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

    *Medications are listed by evidence level as determined by HCVGuidelines.org, then alphabetically.  

    AASLD HCV Re-treatment Recommendations* for People Who Failed Prior Treatment with an NS5A Inhibitor Direct-Acting Antiviral (DAA)


    Genotype 1

    no cirrhosis or

    compensated cirrhosis

    Recommended
    • Vosevi for 12 weeks
    Alternative
    • Mavyret for 16 weeks (except if previously treated with NS3/4 protease inhibitor DAA)

    Genotype 3

    no cirrhosis or

    compensated cirrhosis

    Recommended
    • Vosevi for 12 weeks (+ ribavirin if cirrhosis and prior NS%A failure)
    Alternative

    Genotype 4, 5, 6

    no cirrhosis or

    compensated cirrhosis

    Recommended
    • Vosevi for 12 weeks
    Alternative

    *Medications are listed by evidence level as determined by HCVGuidelines.org, then alphabetically.   

    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: September 27, 2017