There are a variety of hepatitis C treatments offered for all genotypes, with various stages of liver damage.

Improvements in hepatitis C treatment have introduced pan-genotypic treatments, which treat all HCV genotypes (virus strains) with one treatment, shorter treatment time averaging from 8 to 12 weeks for the majority of liver conditions with high cure rates of 95% to 100%.

Over the past several years we’ve seen the landscape of treatment for hepatitis C change. The majority of treatments can be used without ribavirin. Common treatment side effects are headache and fatigue, allowing more patients to work full time while taking treatment.

FDA-approved generic treatments are now available in the U.S. as well as less expensive treatments that have driven higher-cost treatments out of the market.


Determining Which Hepatitis C Treatment to Use

Deciding which hepatitis C treatment is best for each patient will be determined by several factors:

  • Genotype (virus strain)
  • Viral load
  • Liver Condition
  • Other medical conditions
  • Medications the patient takes
  • Any co-infections (Hep B, HIV, or co-infection with more than one genotype at the same time)
  • Associated liver conditions or liver transplant
  • Treatment-naïve or treatment experienced

FDA-approved treatment for Hepatitis C as of 2020


Epclusa: fixed dose of sofosbuvir/velpatasvir

  • For Genotypes: 1, 2, 3, 4, 5, and 6
  • Liver Condition: For patients without cirrhosis or with compensated cirrhosis. For patients with decompensated cirrhosis, ribavirin is used with Epclusa.
  • Dosage: 1 pill per day
  • Treatment Length: 12 weeks
  • Cure Rate: 98%
  • Common Side Effects: headache and fatigue
  • Note: Can be used with or without ribavirin. FDA-approved generic available.


Mavyret: fixed dose of gelcaprevir/pibrentasvir

  • For Genotypes: 1, 2, 3, 4, 5, and 6
  • Liver Condition: For patients without treatment experience without cirrhosis or with compensated cirrhosis. Can be used for genotype 1 previously treated with NS5A inhibitor or NS3/4A protease inhibitor but not both.
  • Dosage: 3 pills, once per day at a set time. Take with food.
  • Treatment Length: 8, 12, or 16 weeks.
  • Cure Rate: 95%-100%
  • Common Side Effects: headache, fatigue
  • Note: Mavyret can also be used for children 12 years or older weighing at least 99 pounds.
  • Caution for hep B reactivation.


Vosevi: fixed dose of sofosbuvir/velpatasvir/voxilaprevi

  • For Genotypes: 1, 2, 3, 4, 5, and 6
  • Liver Condition: For those without cirrhosis, or with compensated cirrhosis. Also used for patients previously treated with advanced hep C regimens
  • Dosage: 1 pill daily with food.
  • Treatment Length: 12 weeks
  • Cure Rates: 91%-100%
  • Common Treatment Side Effects: headache, fatigue, diarrhea, nausea
  • Note: Caution for hep B reactivation


Harvoni: fixed dose of ledipasvir/sovaldi

  • For Genotypes: 1, 4, 5, and 6
  • Liver Condition: For patients with or without compensated cirrhosis. Harvoni is used with ribavirin for genotype 1 with decompensated cirrhosis. Or for genotype 1 or 4 with or without compensated cirrhosis who have had a liver transplant.
  • Dosage: 1 pill per day
  • Treatment Length: 12 weeks
  • Cure Rate: 96%-99%
  • Common Treatment Side Effects: headache and fatigue
  • Note: Harvoni can be used for children. FDA-approved generic available. Harvoni and be used with or without ribavirin.
  • Caution for hepatitis B reactivation.


Zepatier: fixed dose of elbasvir/grazoprevir

  • For Genotypes: 1, 4
  • Liver Condition: For genotype 1 with mutations resistant to treatment or genotype 4 previously treated
  • Dosage: 1 pill per day at a set time with or without food.
  • Treatment Length: 12 or 16 weeks
  • Cure rate: 94%-100%
  • Note: Zepatier can be used with or without ribavirin

Talk to your doctor about which treatment is best suited for you.

*See each medication for full treatment and caution information.

*All treatment options and medications have been reviewed and updated as of January 2020.

References:

HCV Guidelines: AASLD (American Association for the Study of Liver Disease)/IDSA (Infectious Disease Society of America)

This entry was originally published in Life Beyond Hep C, and is reprinted with permission.