People with Gt 1 HCV who did not respond to treatment with a protease inhibitor plus peginterferon-alfa plus ribavirin
The preferred regimen for people with Gt 1 HCV who did not respond to treatment with a protease inhibitor plus pegIFN plus ribavirin is the combination of sofosbuvir plus an NS5A inhibitor (sofosbuvir plus velpatasvir, sofosbuvir plus ledipasvir or sofosbuvir plus daclatasvir) (Table 3). The combination of elbasvir plus grazoprevir is also effective in this population. Response rates are similar to those observed in treatment-naive individuals. The population in whom previous treatment has failed is now a very small group of people.
Non-responders to interferon-free therapy
For people in whom treatment with IFN-free therapy fails, current PBS restrictions do not prohibit patients receiving retreatment with a different IFN-free regimen. However, the evidence to support the use of regimens currently available under the PBS for salvage treatment of HCV is limited, and it is recommended that all individuals in whom first-line DAA therapy fails be referred to a specialist centre where HCV resistance testing is available and there is greater access to evolving salvage treatment strategies via clinical trials.
Retreatment with the same treatment regimen is not recommended. Salvage strategies should include triple combination therapy. Triple-therapy regimens (NS5B, NS5A and NS3 inhibitors) have now been shown in registration studies to be very effective treatment for people in whom DAA therapy fails,61 but are not yet listed on the PBS. It is anticipated that the combination of sofosbuvir (NS5B inhibitor) plus velpatasvir (NS5A inhibitor) plus voxilaprevir (NS3 inhibitor) will be listed on the PBS some time in 2018. The combinations of sofosbuvir plus elbasvir plus grazoprevir, and sofosbuvir plus paritaprevir–ritonavir, ombitasvir and dasabuvir have also been shown to be effective salvage regimens but cannot be prescribed together on the PBS. In people for whom salvage treatment is not urgent, we recommend deferring treatment until salvage regimens become available.