for Veterans and the Public
Chronic Hepatitis C Virus (HCV) Infection: Treatment Considerations
This revision (February 17, 2015) incorporates an update on the treatment of chronic hepatitis C virus (HCV) genotype 1, including the removal of peginterferon-based regimens as recommended treatments for most patients, the recommendation for ledipasvir/sofosbuvir with or without ribavirin, ombitasvir/paritaprevir/ritonavir plus dasabuvir with or without ribavirin or sofosbuvir plus simeprevir for 12-24 weeks, and regimens based on severity of cirrhosis (i.e., by Child-Turcotte-Pugh Score [CTP]). Additional revisions include updates on the off-label use of ledipasvir/sofosbuvir for the treatment of chronic HCV genotypes 2, 3, 4, and in the pre- and post-liver transplant setting. The Panel recommends that HIV/HCV-coinfected patients receive the same HCV antiviral regimen as HCV-monoinfected patients. An Appendix was added that includes new tables summarizing SVR rates for sofosbuvir- and ombitasvir/paritaprevir/ritonavir plus dasabuvir-based regimens (Appendix, Tables 1-3) and drug interaction tables to provide clinicians with guidance on the concomitant use of HCV drugs and other drugs including HIV antiretroviral agents (Appendix, Tables 4 and 5).
This document supplements the Veterans Affairs (VA) Pharmacy Benefits Management (PBM) Criteria For Use documents for HCV antivirals. Information in this document may be used to support individualized treatment decisions based on the existing PBM Criteria For Use documents. The following treatment considerations are based on available medical evidence and represent the consensus of an expert panel of VA HCV clinicians. This document provides an algorithmic approach to assist in clinical decision-making on HCV treatment considerations based on specific patient characteristics including genotype, treatment history, and presence of cirrhosis. The practitioner should interpret these treatment considerations in the clinical context of the individual patient. The content of this document is dynamic and will be revised periodically as new information becomes available.