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 Kidney Disease or HCV Recurrence Post-Liver Transplant:


Genotype 1a

no cirrhosis

Recommended*
  • Daklinza + Sovaldi for 12 weeks
  • Harvoni for 12 weeks
  • Olysio + Sovaldi for 12 weeks
  • Viekira Pak + ribavirin for 12 weeks
  • Zepatier for 12 weeks (without baseline NS5A RAVs1)
Alternative
  • Zepatier + ribavirin for 16 weeks (with baseline NS5A RAVs1)

Genotype 1a

compensated cirrhosis

Recommended*
  • Havroni for 24 weeks
  • Harvoni + ribavirin for 12 weeks
  • Zepatier for 12 weeks (without baseline NS5A RAVs1)
Alternative
  • Daklinza + Sovaldi with/without ribavirin for 24 weeks
  • Olysio + Sovaldi with/without ribavirin for 24 weeks (without Q80K RAVs1)
  • Viekira Pak + ribavirin for 24 weeks
  • Zepatier + ribavirin for 16 weeks (with baseline NS5A RAVs1)

Genotype 1b

no cirrhosis

Recommended*
  • Daklinza + Sovaldi for 12 weeks
  • Harvoni for 12 weeks
  • Olysio + Sovaldi for 12 weeks
  • Viekira Pak for 12 weeks
  • Zepatier for 12 weeks
Alternativen/a

Genotype 1b

compensated cirrhosis

Recommended*
  • Harvoni + ribavirin for 12 weeks
  • Harvoni for 24 weeks
  • Viekira Pak for 12 weeks
  • Zepatier for 12 weeks
Alternative
  • Daklinza + Sovaldi with/without ribavirin for 24 weeks
  • Olysio + Sovaldi with/without ribavirin for 24 weeks

Genotype 2

no cirrhosis

Recommended*
  • Daklinza + Sovaldi for 12 weeks
  • Sovaldi + ribavirin for 12 weeks
Alternativen/a

Geontype 2

compensated cirrosis

Recommended*
  • Daklinza + Sovaldi for 16 to 24 weeks if ribavirin-intolerant
  • Sovaldi + ribavirin for 16 to 24 weeks
Alternative
  • Sovaldi + ribavirin + PEG2 for 12 weeks

Genotype 3

no cirrhosis

Recommended*
  • Daklinza + Sovaldi for 12 weeks
  • Sovaldi + ribavirin + PEG2 for 12 weeks
Alternative

n/a

Geontype 3

compensated cirrosis

Recommended*
  • Daklinza + Sovaldi + ribavirin for 24 weeks
  • Sovaldi + ribavirin + PEG2 for 12 weeks
Alternativen/a

Genotype 4

no cirrhosis

Recommended*
  • Harvoni for 12 weeks
  • Technivie + ribavirin for 12 weeks
  • Zepatier for 12 weeks; Zepatier + ribavirin for 16 weeks if prior treatment failed to suppress HCV
Alternative
  • Sovaldi + ribavirin + PEG2 for 12 weeks
  • Sovaldi + ribavirin for 24 weeks

Geontype 4

compensated cirrosis

Recommended*
  • Harvoni + ribavirin for 12 weeks
  • Harvoni for 24 weeks
  • Technivie + ribarivin for 12 weeks
  • Zepatier for 12 weeks; Zepatier + ribavirin for 16 weeks if prior treatment failed to suppress HCV
Alternative
  • Sovaldi + ribavirin + PEG2 for 12 weeks
  • Sovaldi + ribavirin for 24 weeks

Genotype 5

with/without

compensated cirrhosis

Recommended*
  • Harvoni for 12 weeks
Alternative
  • Sovaldi + ribavirin + PEG2 for 12 weeks

Genotype 6

with/without

compensated cirrhosis

Recommended*
  • Harvoni for 12 weeks
Alternative
  • Sovaldi + ribavirin + PEG2 for 12 weeks

AASLD HCV Re-treatment Recommendations for People Who Failed Prior Treatment with Sovaldi (sofosbuvir) + Ribavirin, with/without PEG1:


Genotype 1

no cirrhosis

Recommended*
  • Harvoni + ribavirin for 12 weeks
Alternativen/a

Genotype 1

with cirrhosis

Recommended*
  • Harvoni + ribavirin for 24 weeks
Alternativen/a

Genotype 2

with/without cirrhosis

Recommended*
  • Daklinza + Sovaldi with/without ribavirin for 24 weeks
  • Sovaldi + ribavarin + PEG2 for 12 weeks
Alternativen/a

Genotype 3

with/without cirrhosis

Recommended*
  • Daklinza + Sovaldi with ribavirin for 24 weeks
  • Sovaldi + ribavirin + PEG2 for 12 weeks
Alternativen/a

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
  • Harvoni for 12 weeks
  • Zepatier + ribavirin for 12 weeks; 16 weeks for genotype 1a with baseline NS5A RAVs1
Alternativen/a

Genotype 1

with cirrhosis

Recommended*
  • Daklinza + Sovaldi with/without ribavirin for 24 weeks
  • Harvoni + ribavirin for 12 weeks
  • Harvoni for 24 weeks
  • Zepatier + ribavirin for 12 weeks; 16 weeks for genotype 1a with baseline NS5A RAVs1
Alternativen/a

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

n/a

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
Alternativen/a

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

1 RAVs = resistance-associated variants 
2 PEG = peginterferon

Medications that are NOT recommended for people who failed prior treatment:

Genotype 1 (Failed prior treatment with an HCV protease inhibitor)

  • Any regimen containing peginterferon with/without Incivek, Olysio, ribavirin, Sovaldi, or Victrelis
  • Monotherapy with peginterferon, ribavirin or a direct-acting antiviral
  • Any peginterferon-free regimen containing Olysio or paritaprevir (found in Technivie and Viekira)

Genotype 2 (Failed prior treatment with peginterferon/ribavirin)

  • Peginterferon plus ribavirin with/without Incivek or Victrelis
  • Harvoni
  • Monotherapy with peginterferon, ribavirin or a direct-acting antiviral

Genotype 3 (Failed prior treatment with peginterferon/ribavirin)

  • Peginterferon plus ribavirin for 24 to 48 weeks
  • Monotherapy with peginterferon, ribavirin or a direct-acting antiviral
  • Regimens using Incivek, Olysio, or Victrelis

Genotype 4, 5, 6 (Failed prior treatment with peginterferon/ribavirin)

  • Peginterferon plus ribavirin with/without Incivek 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: February 25, 2016