Genotype 3-hepatitis C virus’ last line of defense

Table 2 European Association for the Study of the Liver and American Association for the Study of Liver Diseases/Infectious Diseases Society of America current recommendations on the treatment of genotype 3-infected patients

Recommendations	Genotype/subtype	Cirrhosis status	Prior treatment experience	SOF/VEL	GLE/PIB	SOF/VEL/VOX	GZR/EBR + SOF
European Association for the Study of the Liver[78]	GT3	No cirrhosis	Treatment-naïve	12 wk	8 wk	-	-
			Treatment-experienced		12 wk	-	-
		Compensated cirrhosis	Treatment-naïve	12 wk with RBV1	8-12 wk2	12 wk	-
			Treatment-experienced		16 wk		-
		Decompensated cirrhosis	Treatment-naïve and experienced	12 wk with RBV or 24 wk	-	-	-
	GT3, subtype b, g or any other subtype naturally harbouring one or several NS5A RASs3	No cirrhosis	Treatment-naïve	Unknown	Unknown	12 wk	-
			Treatment-experienced				-
		Compensated cirrhosis	Treatment-naïve				-
			Treatment-experienced				-
AASLD/IDSA (Ghany et al[79])	GT3	No cirrhosis	Treatment-naïve	12 wk	8 wk	-	-
			Treatment-experienced	12 wk	16 wk4	12 wk4	-
			SOF + RBV ± PEGIFN-experienced	-	16 wk	12 wk	-
			DAA-experienced5	-	-	12 wk, + RBV for NS5A failures	-
		Compensated cirrhosis	Treatment-naïve	12 wk, + RBV for 12 wk4	8 wk	12 wk4	-
			PEGIFN + RBV-experienced	+ RBV for 12 wk4	16 wk	12 wk	12 wk4
			SOF + RBV ± PEGIFN-experienced	-	16 wk	12 wk	-
			DAA-experienced5	-	-	12 wk, + RBV for NS5A failures	-
		Decompensated cirrhosis	Treatment-naïve and experienced	12 wk with RBV or 24 wk	-	-	-

¹If resistance testing is performed, only patients with the nonstructural protein 5A Y93H resistance-associated substitutions at baseline should be treated with sofosbuvir/velpatasvir plus ribavirin or with sofosbuvir/velpatasvir/voxilaprevir, whereas patients without the Y93H resistance-associated substitutions should be treated with sofosbuvir/velpatasvir alone.

²In treatment-naïve patients infected with genotype 3 with compensated (Child-Pugh A) cirrhosis, treatment with glecaprevir/pibrentasvir can be shortened to 8 wk, but more data are needed to consolidate this recommendation.

³As determined by sequence analysis of the nonstructural protein 5A region by means of population sequencing or deep sequencing (cutoff 15%).

⁴Alternative regimen.

⁵Including nonstructural protein 5A inhibitors except glecaprevir/pibrentasvir failures. NS5A: Nonstructural protein 5A; SOF: Sofosbuvir; VEL: Velpatasvir; GLE: Glecaprevir; PIB: Pibrentasvir; VOX: Voxilaprevir; GZR: Grazoprevir; EBR: Elbasvir; EASL: European Association for the Study of the Liver; GT: Genotype; RBV: Ribavirin; PEGIFN: Pegylated interferon; DAA: Direct-acting antivirals; AASLD/IDSA: American Association for the Study of Liver Diseases/Infectious Diseases Society of America.