How is HCV treated: which DAAs and for how long


Direct-acting antivirals (DAAs)

In 2017, all guidelines recommend that chronic HCV should be treated with all oral combinations of DAAs. This includes treatment for all HIV positive people.

These drugs have high cure rates and very few side effects.

DAAs usually involve only one or two pills a day for 12 weeks. In some cases treatment takes longer.

Some DAAs are only active against certain HCV genotypes. This means that the combination that your doctor recommends with be individual to you.

Current single DAAs and fixed dose combination (FDC) tablets are listed in Table 2 below. Other DAAs are in development and are likely to be approved in the near future.

How well does treatment work?

The high cure rates (more than 95%) shows that DAAs are effective enough to treat nearly everyone.

Even in people with cirrhosis, although cure rates are lower, they are still around 80%.

How long is HCV treatment?

DAAs generally only need treatment that lasts for 12 weeks.

The need for longer treatment depends on treatment history, sub-genotype, HCV viral load, cirrhosis and drug resistance.

Some researchers are looking at whether shorter DAA treatment might be possible.

Treatment with older HCV drugs (pegylated interferon and ribavirin) used to be for 6 to 12 months.

Table 2. DAAs, genotypes and NICE comments  * 

DAA or combination ** Class or classes Genotypes NICE comments for cost-effectiveness (treatment is different) §
daclatasvir (Daklinza)

Once daily.

NS5A inhibitor. All, less data on G5 & G6. G1: for people with pre-cirrhosis, with sofosbuvir

G4: with PEG-IFN and RBV (though this combination will NOT be used).

elbasvir/grazoprevir (Zepatier)Once daily. FDC: HCV protease inhibitor and NS5A inhibitor. 1 and 4. Cannot be used with HIV protease inhibitors or efavirenz due to drug interactions. HIV treatment needs to be temporarily changed.
paritaprevir/r/ombitasvir (Viekirax) with dasabuvir  (Exviera)

Twice daily.

FDC: boosted HCV PI/NS5A inhibitor, (with non nucleoside polymerase inhibitor (G1). 1 and 4. G1a, no cirrhosis: 12 weeks + RBV; with cirrhosis, 24 weeks + RBV;

G1b, no cirrhosis: 12 weeks; add RBV for cirrhosis.

G4: no dasabuvir, add RBV, 12 weeks; for cirrhosis, treat for 24 weeks.

sofosbuvir  (Sovaldi)

Once daily.

Nucleotide polymerase inhibitor. All

(G1, 2, 3, 4, 5, 6, 7)

Recent approvals of other DAAs mean that all oral treatments that include sofosbuvir are now available for all genotypes.
sofosbuvir/ledipasvir (Harvoni)

Once daily.

FDC of nucleotide polymerase inhibitor/NS5A inhibitor. 1,4, 5 and 6. G1 (not cirrhosis): 8 weeks.

G1 and 4 (naive, experienced with and without cirrhosis): 12 weeks.

With cirrhosis: 12 weeks only if risk of progression is low. Longer treatment needed for decompensated cirrhosis but not funded.

sofosbuvir/velpatasvir (Epclusa)

Once daily.

FDC: nucleotide polymerase inhibitor/NS5A inhibitor. All.

(G1, 2, 3, 4, 5, 6, 7)

NICE recommend for all genotypes, treated or untreated (except G2; only for people not cured by or who cannot use PEG-IFN).

For decompensated cirrhosis, all genotypes: add RBV.

KEY: FDC: Fixed dose combination; G: genotype; PEG-IFN: pegylated interferon; RBV: ribavirin.

* Access is more dependent on commissioning guidelines (ie NHS England or other regions). ** Simeprevir is not included due to low use. RBV is taken twice-daily.

§ See EASL guidelines (2016) for treatment recommendations by genotype.

Current DAAs

Current DDAs include: daclatasvir, dasabuvir, elbasvir, grazoprevir, ledipasvir, ombitasvir, paritaprevir/r, simeprevir, sofosbuvir and velapatasvir.

Single and combined formulations (Brand names in brackets) include:

How long is HCV treatment?

Modern HCV drugs (DAAs) generally only need 12 weeks treatment.

Sometimes, treatment might be longer, in complicated cases.

Some researchers are looking at whether shorter DAA treatment might be possible.

Older HCV drugs – pegylated interferon and ribavirin – used to normally need treatment for at least a year.

Old HCV drugs: interferon and ribavirin

The high cost of DAAs means that not everyone has access to these new DAA drugs.

For people who can still only access pegylated interfreon and ribavirin, information about these older drugs is included below.

Ribavirin – still sometimes recommended with DAAs

Ribavirin is a nucleoside analogue similar to some HIV drugs (“nukes”).

On its own, ribavirin does not directly work against HCV or HIV. When it is used with peginterferon it improves the response to HCV treatment.

Ribavirin is an oral drug, given as pills or capsules, twice daily. It is usually dosed by body weight. Brand names for ribavirin include Copegus, Rebetrol and Ribasphere.

See: Old HIV drugs: peg interferon and ribavirin

Peginterferon – no longer recommended

Interferon is a man-made version of a chemical that your body already produces. It works directly against HCV but also stimulates the immune system to fight viruses.

See: Old HIV drugs: peg interferon and ribavirin

First HCV protease inhibitors: boceprevir and telaprevir

Boceprevir and telaprevir are no longer recommened for anyone.

They were the first direct-acting antivirals (DAAs) to be approved but had too many difficult side effects to still be used.

Last updated: 17 August 2017.