Summary: Patients With Decompensated Cirrhosis
Recommended for All Patients With HCV Infection Who Have Decompensated Cirrhosis 
|
|
RECOMMENDED
|
RATING 
|
|
Patients with HCV infection who have decompensated cirrhosis—moderate or severe hepatic impairment, ie, Child-Turcotte-Pugh (CTP) class B or class C—should be referred to a medical practitioner with expertise in that condition, ideally in a liver transplant center.
|
I, C
|
Decompensated Cirrhosis Genotype 1-6
Recommended regimens listed by pangenotypic, evidence level and alphabetically for:
Patients With Decompensated Cirrhosisa Who Have Genotype 1-6 and Are Ribavirin Eligible
|
|
RECOMMENDED
|
DURATION
|
RATING
|
|
Genotype 1-6: Daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 mg) with weight-based ribavirinb
|
12 weeks
|
I, Ac
|
|
Genotype 1, 4, 5, or 6 only: Daily fixed-dose combination of ledipasvir (90 mg)/sofosbuvir (400 mg) with low initial dose of ribavirin (600 mg, increase as tolerated to weight-based dose)
|
12 weeks
|
I, Ad
|
a Includes CTP class B and class C patients who may or may not be candidates for liver transplantation, including those with hepatocellular carcinoma.
b Low initial dose of ribavirin (600 mg) is recommended for patients with CTP class C cirrhosis; increase as tolerated.
c Only available data for genotype 6 are in patients with compensated cirrhosis.
d Only available data for genotypes 5 and 6 are in a small number of patients with compensated cirrhosis.
|
Recommended regimens listed by pangenotypic, evidence level and alphabetically for:
Patients With Decompensated Cirrhosisa Who Have Genotype 1-6 and Are Ribavirin Ineligible
|
|
RECOMMENDED
|
DURATION
|
RATING
|
|
Genotype 1-6: Daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 mg)
|
24 weeks
|
I, Ab
|
|
Genotype 1, 4, 5, or 6 only: Daily fixed-dose combination of ledipasvir (90 mg)/sofosbuvir (400 mg)
|
24 weeks
|
I, Ac
|
a Includes CTP class B and class C patients who may or may not be candidates for liver transplantation, including those with hepatocellular carcinoma.
b Only available data for genotype 6 are in patients with compensated cirrhosis.
c Only available data for genotypes 5 and 6 are in a small number of patients with compensated cirrhosis.
|
Recommended regimens listed by pangenotypic, evidence level and alphabetically for:
Patients With Decompensated Cirrhosisa and Genotype 1-6 Infection in Whom Prior Sofosbuvir- or NS5A Inhibitor-Based Treatment Failed
|
|
RECOMMENDED
|
DURATION
|
RATING
|
|
Genotype 1-6: Daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 mg) with weight-based ribavirinb
|
24 weeks
|
II, Cc
|
|
Prior sofosbuvir-based treatment failure, genotype 1, 4, 5, or 6 only: Daily fixed-dose combination of ledipasvir (90 mg)/sofosbuvir (400 mg) with low initial dose of ribavirin (600 mg; increase as tolerated)
|
24 weeks
|
II, Cd
|
|
a Includes CTP class B and class C patients who may or may not be candidates for liver transplantation, including those with hepatocellular carcinoma.
b Low initial dose of ribavirin (600 mg) is recommended for patients with CTP class C cirrhosis.
c Only available data for genotypes 5 and 6 are in a small number of patients with compensated cirrhosis.
d Only available data for genotype 6 are in patients with compensated cirrhosis.
|
Regimens not recommended for:
Patients With Decompensated Cirrhosis (Moderate or Severe Hepatic Impairment; Child-Turcotte-Pugh Class B or C)
|
|
NOT RECOMMENDED
|
RATING
|
|
Any protease inhibitor-containing regimen (eg, glecaprevir, grazoprevir, and voxilaprevir).
|
III, B
|
|
Interferon-based regimens
|
III, B
|
