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

The length of treatment will depend on; genotype, liver condition, viral load, and if any prior treatment history.  See each treatment for information on side effects and other important information.

FDA-Approved Treatment for Hepatitis C As of 2021

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. U.S. 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 lbs.

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. U.S. 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 February 2021.

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This entry was originally published on Life Beyond Hepatitis C on March 31, 2021 and is reprinted with permission.