Treatment of Chronic Hepatitis C After Sofosbuvir-Based Regimen Failure

When a sofosbuvir-based regimen fails to achieve the treatment target in adults with chronic hepatitis C — whether or not compensated cirrhosis is present — a specific retreatment strategy is indicated. This scenario requires a different approach from initial therapy.

Clinical Scenario

Adults with chronic hepatitis C infection without cirrhosis, or with compensated cirrhosis, in whom a prior sofosbuvir-based regimen did not result in a sustained virologic response.

Treatment Goal

Sustained virologic response 12 weeks after completion of therapy (SVR12) — confirmed undetectable HCV RNA.

Retreatment Approach

Retreatment centres on a pangenotypic combination antiviral regimen. Specific modifications and alternative options depend on viral genotype and the presence of compensated cirrhosis — the full protocol details which regimen applies and under what conditions.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/cid/ciad319

Generally, persons who have experienced treatment failure with a sofosbuvir-based regimen should be retreated with 12 weeks of sofosbuvir/velpatasvir/voxilaprevir.
The exception is persons with genotype 3 infection and compensated cirrhosis for whom the addition of weight-based ribavirin to the regimen is recommended.
Glecaprevir/pibrentasvir for 16 weeks can be used as an alternative retreatment regimen.
SVR12, sustained virologic response 12 weeks after completion of therapy.

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