I have worked in the hepatitis C field for about eighteen years. In 1997, there was one hepatitis C treatment - interferon. Eventually, ribavirin was approved, and until 2011, I only had to remember the brand names of these two medications. In short, hepatitis C treatment didn’t change much. 

Then came all the “virs” - boceprevir (Victrelis), telaprevir (Incivek), simeprevir (Olysio), sofosbuvir (Sovaldi), and ledipasvir (when combined with sofosbuvir = Harvoni). Ombitasvir, paritaprevir, ritonavir and dasabuvir (Viekira Pak, aka PrOD) caused my brain to explode, and we are just getting started. 

What we know about hepatitis C and how to treat is changing faster than versions of Windows and iPhones. Thank goodness, because the death rate of this disease is increasing. Ditto for the number of new infections. 

Recently, the HCV Guidelines changed. This is my hep C bible, written by the American Association for the Study of Liver Diseases (AASLD) and Infectious Diseases Society of America (IDSA). Here are some of the changes:

  • Recommended treatment/retreatment for genotype 3 was changed to sofosbuvir (Sovaldi), ribavirin, and peginterferon for 12 weeks. Sofosbuvir plus ribavirin for 24 weeks is an alternative treatment. 
  • Recommended treatment/retreatment for genotype 5 patients is 12 weeks of ledipasvir/sofosbuvir. Alternative HCV treatment is 12 weeks of sofosbuvir, ribavirin, and peginterferon.
  • There were also changes to genotype 1 regimens using simeprevir/sofosbuvir or PrOD
  • The addition of re-treatment recommendations for patients who failed prior treatment with sofosbuvir plus ribavirin, with/without peginterferon. Prior to this update, there were no recommendations for genotype 1 patients without cirrhosis who had failed treatment with sofosbuvir. Now, 12 weeks of ledipasvir/sofosbuvir is recommended. 
Other updates were added to the retreatment portion. The updated guidelines are nicely summarized at HepMag.com or you can read the entire HCV guidelines here.