Impact of direct-acting antiviral regimens on hepatic and extrahepatic manifestations of hepatitis C virus infection

Table 2 Recommended direct-acting antiviral regimens for treatment of hepatitis C virus infection according to AASL/ADSA 2021

Treatment	No cirrhosis		Compensated cirrhosis		Decompensated cirrhosis
	Naïve HCV infected patient	Previously treated patients	Naïve HCV infected patients	Previously treated patients
Sofosbuvir (400 mg)/Velpatasvir (100 mg)	12 wk	Sofosbuvir (400 mg)/Velpatasvir (100 mg)/Voxilapevir (100 mg), 12 wk, for all genotypes. ALTERNATIVE: Glecaprevir (300 mg)/Pibrentasvir (120 mg), but not recommended for genotype 3 with Sofosbuvir/NS5A inhibitor	For genotypes 1, 2, 4, 5, and 6 & genotype 3 with NS5A-RAS Y93H negative, 12 wk, but not recommended for genotype 3 with NS5A-RAS Y93H positivity	Sofosbuvir (400 mg)/Velpatasvir (100 mg)/Voxilapevir (100 mg), 12 wk, for genotypes 1, 2, 4, 5, and 6; for genotype 3, 12 wk in addition to weight-based Ribavirin. ALTERNATIVE: Glecaprevir (300 mg)/Pibrentasvir (120 mg), but not recommended for genotype 3 with Sofosbuvir/NS5A inhibitor	Patients with HCV infection who have decompensated cirrhosis, i.e., Child-Pugh class B or class C, should be referred to a medical practitioner with expertise in that condition, ideally in a liver transplant center
Glecaprevir (300 mg)/Pibrentasvir (120 mg)	8 wk	16 wk in addition to Sofosbuvir (400 mg) + weight-based Ribavirin ALTERNATIVE: 12 wk of Sofosbuvir (400 mg)/Velpatasvir (100 mg)/Voxilapevir (100 mg)	8 wk	16 wk in addition to Sofosbuvir (400 mg) + weight-based Ribavirin. ALTERNATIVE: 12 wk of Sofosbuvir (400 mg)/Velpatasvir (100 mg)/Voxilapevir (100 mg) in addition to weight-based Ribavirin
Elbasvir (50 mg)/Grazoprevir (100 mg)	12 wk for genotype 1b	12 wk Sofosbuvir (400 mg)/Velpatasvir (100 mg)/Voxilapevir (100 mg). However, Glecaprevir/Pibrentasvir for 16 wk is not recommended as an alternative for this group of patients	12 wk for genotype 1B	NA

HCV: Hepatitis C virus; RAS: Resistance-associated substitutions; NA: Not applicable