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 (Medications are listed first by evidence level according to the HCVGuidelines.org, then listed alphabetically.)
| Recommended | Alternative |
|---|
| Genotype 1a no cirrhosis | - Epclusa* for 12 weeks
- Harvoni* for 12 weeks
- Mavyret for 8 weeks
- Zepatier for 12 weeks (without baseline NS5A RASs**)
| - Daklinza + Sovaldi for 12 weeks
- Zepatier + ribavirin for 16 weeks (with baseline NS5A RASs**)
|
| Genotype 1a compensated cirrhosis | - Epclusa* for 12 weeks
- Zepatier for 12 weeks (without baseline NS5A RASs**)
- Mavyret for 12 weeks
| - Harvoni* + ribavirin for 12 weeks
- Zepatier + ribavirin for 16 weeks (with baseline NS5A RASs**)
|
| Genotype 1b no cirrhosis | - Epclusa* for 12 weeks
- Harvoni* for 12 weeks
- Mavyret for 8 weeks
- Zepatier for 12 weeks
| - Daklinza + Sovaldi for 12 weeks
|
| Genotype 1b compensated cirrhosis | - Epclusa* for 12 weeks
- Zepatier for 12 weeks
- Mavyret for 12 weeks
| - Harvoni* + ribavirin for 12 weeks
|
| Genotype 2 no cirrhosis | - Epclusa* for 12 weeks
- Mavyret for 8 weeks
| - Daklinza + Sovaldi for 12 weeks
|
| Geontype 2 compensated cirrhosis | - Epclusa* for 12 weeks
- Mavyret for 12 weeks
| - Daklinza + Sovaldi for 16 to 24 weeks
|
| Genotype 3 no cirrhosis | | - Daklinza + Sovaldi for 12 weeks
- Mavyret for 16 weeks
- Vosevi for 12 weeks (with Y93H RASs**)
|
| Geontype 3 compensated cirrhosis | - Zepatier + Sovaldi for 12 weeks
- Vosevi for 12 weeks
| - Epclusa* + ribavirin for 12 weeks
- Mavyret for 16 weeks
|
| Genotype 4 no cirrhosis | - Epclusa* for 12 weeks
- Mavyret for 8 weeks
- Harvoni* for 12 weeks
- Zepatier for 12 weeks for responder-relapsers to prior treatment
| - Zepatier + ribavirin for 16 weeks if prior treatment failed to suppress HCV
|
| Geontype 4 compensated cirrhosis | - Epclusa* for 12 weeks
- Mavyret for 12 weeks
- Zepatier for 12 weeks for responder-relapsers to prior treatment
| - Harvoni* + ribavirin for 12 weeks
- Zepatier + ribavirin for 16 weeks if prior treatment failed to suppress HCV
|
| Genotype 5 no cirrhosis | - Epclusa* for 12 weeks
- Harvoni* for 12 weeks
- Mavyret for 8 weeks
| |
| Genotype 5 compensated cirrhosis | - Mavyret for 12 weeks
- Epclusa* for 12 weeks
- Harvoni* for 12 weeks
| |
| Genotype 6 no cirrhosis | - Epclusa* for 12 weeks
- Harvoni* for 12 weeks
- Mavyret for 8 weeks
| |
| Genotype 6 compensated cirrhosis | - Mavyret for 12 weeks
- Epclusa* for 12 weeks
- Harvoni* for 12 weeks
| |
| 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 | - 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 | - 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
|
| 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 | |
| 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 | - 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 | - 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 | |
*Generic version is available in the United States.
**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)
(Medications are listed first by evidence level according to the HCVGuidelines.org, then listed alphabetically.)
| Recommended | Alternative |
|---|
| Genotype 1 no cirrhosis | - Epclusa* for 12 weeks
- Harvoni* for 12 weeks
- Mavyret 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**
|
| Genotype 1 compensated cirrhosis | - Epclusa* for 12 weeks
- Mavyret for 12 weeks
| - 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**
|
| 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**
|
*Generic version is available in the United States.
** RASs = resistance-associated substitutions (formerly RAVs or resistance-associated variants)
AASLDHCV Re-treatment Recommendations for People Who Failed Prior Non-NS5A Inhibitor Treatment Containing Sovaldi (Medications are listed first by evidence level according to the HCVGuidelines.org, then listed alphabetically.)
| Recommended | Alternative |
|---|
| Genotype 1 no cirrhosis | - Vosevi for 12 weeks
- Epclusa* for 12 weeks
- Mavyret for 12 weeks
| - Harvoni* + ribavirin for 12 weeks (except when previously failed Olysio treatment)
|
| Genotype 1 compensated cirrhosis | - Vosevi for 12 weeks
- Epclusa* for 12 weeks
- Mavyret for 12 weeks
| |
| Genotype 2 no cirrhosis | - Epclusa* for 12 weeks
- Mavyret for 12 weeks
| |
| Genotype 2 compensated cirrhosis | - Epclusa* for 12 weeks
- Mavyret for 12 weeks
| |
| Genotype 3 no cirrhosis | | |
| Genotype 3 compensated cirrhosis | - Vosevi + ribavirin for 12 weeks
| |
| Genotype 4 no cirrhosis | | |
| Genotype 4 compensated cirrhosis | | |
| Genotype 5 or 6 no cirrhosis | | |
| Genotype 5 or 6 compensated cirrhosis | | |
| 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 | |
| Alternative | |
| Genotype 3 compensated cirrhosis |
|---|
| Recommended | - Vosevi + ribavirin for 12 weeks
|
| Alternative | |
| Genotype 4 no cirrhosis |
|---|
| Recommended | |
| Alternative | |
| Genotype 4 compensated cirrhosis |
|---|
| Recommended | |
| Alternative | |
| Genotype 5 or 6 no cirrhosis |
|---|
| Recommended | |
| Alternative | |
| Genotype 5 or 6 compensated cirrhosis |
|---|
| Recommended | |
| Alternative | |
*Generic version is available in the United States.
AASLD HCV Re-treatment Recommendations for People Who Failed Prior Treatment with an NS5A Inhibitor Direct-Acting Antiviral (DAA) (Medications are listed first by evidence level according to the HCVGuidelines.org, then listed alphabetically.)
| Recommended | Alternative |
|---|
| Genotype 1 no cirrhosis or compensated cirrhosis | | - Mavyret for 16 weeks (except if previously treated with NS3/4 protease inhibitor DAA)
|
| Genotype 3 no cirrhosis or compensated cirrhosis | - Vosevi for 12 weeks (+ ribavirin if cirrhosis and prior NS%A failure)
| |
| Genotype 4, 5, 6 no cirrhosis or compensated cirrhosis | | |
| Genotype 1 no cirrhosis or compensated cirrhosis |
|---|
| Recommended | |
| 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 | |
| Alternative | |
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 Reviewed: March 11, 2019
