In the United States, genotype 1 HCV is the most common infection, accounting for approximately 70 to 75% of all hepatitis C infections. Accordingly, treatment of genotype 1 has the most extensive data and highest clinical relevance for hepatitis C treatment issues in the United States. Genotype 1 infection has been historically difficult to treat, but multiple recent studies have shown SVR rates greater than 90% in these genotype 1 patients using well-tolerated, all-oral regimens consisting of new direct-acting antiviral agents. The use of these direct-acting antiviral agents has been complicated by the high price of therapy. For example, the cost of the preferred regimens in the 2014 AASLD/IDSA/IAS-USA Guidance for treatment of genotype 1 infection range from approximately $63,000 to $150,000 in patients without cirrhosis and $84,000 to $300,000 in those with cirrhosis (Figure 1). The following discussion regarding initial treatment and retreatment of patients with genotype 1a or 1b chronic hepatitis C assumes the patient and their clinician have already made the decision to initiate hepatitis C therapy.
Click Here for More information on Hepatitis C Treatment
Genotype 1 Chronic HCV: Initial Treatment Treatment-Naive Patients with Genotype 1 Infection |
Recommended regimen for retreatment of Genotype 1a without cirrhosis
|
Ledipasvir - Sofosbuvir
Fixed-dose
combination of ledipasvir (90 mg)/sofosbuvir (400 mg) once daily x 12 weeks
|
Recommended regimen for retreatment of Genotype 1a without cirrhosis
|
Ombitasvir-Paritaprevir-Ritonavir and Dasabuvir
Fixed-dosecombination of ombitasvir (12.5 mg)/paritaprevir (75 mg)/ritonavir (50 mg) two tablets once daily plus
+
Ribavirin
1000 mg if ≥75 kg x 12 weeks (no cirrhosis) or 24 weeks (cirrhosis)g
|
Genotype 1 Chronic HCV: Retreatment
Prior Treatment Failure (received Sofosbuvir-Containing Regimen)
|
Recommended regimens for patients without advanced fibrosis
Rating: Class IIb, Level C
Note: Based on the limited data available for effective therapy, patients without an urgent need for
HCV treatment should defer antiviral therapy pending additional data or consider treatment within clinical trial settings
Recommended regimen for patients with advanced fibrosis
Ledipasvir-Sofosbuvir
Fixed-dose combination of ledipasvir (90 mg)/sofosbuvir (400 mg) once daily x 24 weeks
±
Ribavirin 1000 mg if or 1200 mg if ≥75 kg x 24 weeks
|
Genotype 1 Chronic HCV: Retreatment
Prior Treatment Failure (received Sofosbuvir-Containing Regimen)
|
Recommended regimens for patients without advanced fibrosis
Rating: Class IIb, Level C
Note: Based on the limited data available for effective therapy, patients without an urgent need for HCV treatment should defer antiviral therapy pending additional data or consider treatment within clinical trial settings.
Recommended regimen for patients with advanced fibrosis
Ledipasvir-Sofosbuvir
Fixed-dose combination of ledipasvir (90 mg)/sofosbuvir (400 mg) once daily x 24 weeks ± Ribavirin 1000 mg
Rating: Class IIa, Level C
Note: The ribavirin daily dose is given in two divided doses.
|
Genotype 1 Chronic HCV: Retreatment
Prior Treatment Failure (received Peginterferon, Ribavirin, and HCV Protease Inhibitor)
Recommended regimen for patients without cirrhosis, regardless of genotype 1 subtype
|
Ledipasvir - Sofosbuvir
Fixed-dose combination of ledipasvir (90 mg)/sofosbuvir (400 mg) once daily x 12 weeks
|
Genotype 1 Chronic HCV: Retreatment
Prior Treatment Failure (received Peginterferon, Ribavirin, and HCV
Protease Inhibitor)
Recommended regimen for patients with cirrhosis, regardless of genotype 1 subtype
|
Ledipasvir - Sofosbuvir
Fixed-dose combination of ledipasvir (90 mg)/sofosbuvir (400 mg) once daily x 12 weeks
|
Recommended regimen for
Genotype 1a
|
Sofosbuvir
400 mg once daily x 12 weeks (no cirrhosis) or 24 weeks (cirrhosis)+
+
Simeprevir
150 mg once daily x 12 weeks (no cirrhosis) or 24 weeks (cirrhosis)
+
Ribavirin
1000 mg/day if
Rating: Class IIa, Level B
Note: The ribavirin daily dose is given in two divided doses
|
Recommended regimen for
Genotype 1b
|
Ledipasvir- Sofosbuvir
Fixed-dosecombination of ledipasvir (90 mg)/sofosbuvir (400 mg) one tablet once daily x 12 weeks*
Rating: Class I, Level A
Note: *In the ION-3 trial, patients without cirrhosis and a baseline HCV RNA levels less than 6 million IU/ml had similar relapse rates when treated with 8 weeks versus 12 weeks. Decreasing the length of the regimen to 8 weeks should be done with caution.
|
Recommended regimen for
Genotype 1b
|
Ombitasvir-Paritaprevir-Ritonavir and Dasabuvir
Fixed-dose combination of ombitasvir (12.5 mg)/paritaprevir (75 mg)/ritonavir (50 mg) two tablets once daily plus dasabuvir (250 mg) one tablet twice daily x 12 weeks
+
Ribavirin
For patients with cirrhosis, the addition of ribavirin (1000 mg/day if kg or 1200 mg/day if ≥75 kg x 12 weeks is recommended
Rating: Class I, Level A
Note: The ribavirin daily dose is given in two divided doses.
|
Recommended regimen for
Genotype 1b
|
Sofosbuvir
400 mg once daily x 12 weeks (no cirrhosis) or 24 weeks (cirrhosis)
+
Simeprevir
150 mg once daily x 12 weeks (no cirrhosis) or 24 weeks (cirrhosis)
Rating: Class II, Level B
|
Source: Hepatitis C Online