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
  • Epclusa 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 RAVs**)

Genotype 1a

compensated cirrhosis

Recommended
  • Epclusa for 12 weeks
  • Harvoni + ribavirin 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 Pak + 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
  • Olysio + Sovaldi for 12 weeks
  • Viekira Pak for 12 weeks
  • Zepatier for 12 weeks
Alternativen/a

Genotype 1b

compensated cirrhosis

Recommended
  • Epclusa for 12 weeks
  • Harvoni + ribavirin for 12 weeks
  • Viekira Pak 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
Alternative
  • Daklinza + Sovaldi for 12 weeks

Geontype 2

compensated cirrosis

Recommended
  • Epclusa 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
Alternative

n/a

Geontype 3

compensated cirrosis

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

Genotype 4

no cirrhosis

Recommended
  • Epclusa for 12 weeks
  • 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

    Geontype 4

    compensated cirrosis

    Recommended
    • Epclusa for 12 weeks
    • 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

    Genotype 5

    with/without

    compensated cirrhosis

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

    Genotype 6

    with/without

    compensated cirrhosis

    Recommended
    • Epclusa for 12 weeks
    • Harvoni 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 Sovaldi (sofosbuvir) + Ribavirin, with/without Peginterferon:


    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
    • Epclusa for 12 weeks
    Alternative
    • Daklinza + Sovaldi with/without ribavirin for 24 weeks

    Genotype 3

    with/without cirrhosis

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

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

    Genotype 1

    with cirrhosis

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

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

    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, medications are listed alphabetically

    ** RAVs = resistance-associated variants 

    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: June 29, 2016