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Uptodate Reference Title
Antiviral selection for HCV genotype 2 infection in adults[1]
Antiviral selection for HCV genotype 2 infection in adults[1]
The choice between these regimens is based on potential drug interactions, patient preference regarding dosing, local availability, and individual financial or insurance limitations. Overall, we suggest glecaprevir-pibrentasvir or sofosbuvir-velpatasvir regimens for patients without prior NS5A inhibitor exposure. They are extremely effective against genotype 2 infection. Daclatasvir plus sofosbuvir also appears highly effective, but has been studied in only a small number of genotype 2-infected patients.
Doses of direct acting antivirals are standard. Daclatasvir dose adjustment is warranted with concomitant use of P450 inducers and inhibitors. If ribavirin is used, dosing is weight based: 1000 mg daily if <75 kg and 1200 mg daily if ≥75 kg.
This algorithm does not apply to patients with estimated glomerular filtration rate <30 mL/min per 1.73 m2 (or on dialysis). Refer to UpToDate content on HCV treatment in patients with renal impairment for more details.
HCV: hepatitis C virus. * Ascites, hepatic encephalopathy, prolonged prothrombin time, decreased serum albumin, and/or hyperbilirubinemia. ¶ This population includes patients who are treatment naïve or failed prior treatment with peginterferon plus ribavirin. Δ In locations where fixed combination regimens are available, daclatasvir plus sofosbuvir does not offer an advantage and is likely more costly or difficult to access. However, it is the main option in many resource-limited settings. ◊ Among patients with cirrhosis, glecaprevir-pibrentasvir is given for 8 weeks to those who are treatment-naïve and 12 weeks to those who have failed prior treatment with peginterferon plus ribavirin. § Glecaprevir-pibrentasvir is given for 8 weeks for those without cirrhosis and 12 weeks for those with compensated cirrhosis.
Reference:
AASLD-IDSA. Recommendations for testing, managing, and treating hepatitis C. http://www.hcvguidelines.org. Accessed August 23, 2017.
