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HCV DAA Failure Retreatment — SCE Infectious Diseases MCQ

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HardHepatitisHCV DAA Failure RetreatmentSCE Infectious Diseases

A 35-year-old man with chronic HCV (genotype 1a) and compensated cirrhosis fails a first course of Sofosbuvir/Ledipasvir. Resistance testing shows NS5A resistance-associated substitutions (RASs). What is the recommended retreatment regimen?

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Correct answer: A — Sofosbuvir/Velpatasvir/Voxilaprevir for 12 weeks (rescue triple DAA regimen for DAA failures)

For patients who fail a prior NS5A-containing DAA regimen with documented NS5A RASs, the EASL-recommended retreatment is Sofosbuvir/Velpatasvir/Voxilaprevir (Vosevi) for 12 weeks. Voxilaprevir is an NS3/4A protease inhibitor that provides additional antiviral activity. For genotype 3 with cirrhosis and prior NS5A failure, Ribavirin may be added. Simply repeating the failed regimen or using another NS5A-only combination is unlikely to overcome resistance. Resistance-guided therapy is increasingly used.

Reference: NICE TA507 2018 – Sofosbuvir/Velpatasvir/Voxilaprevir; EASL 2024 – HCV retreatment