Background: In the United States, genotype 1 HCV is the most common infection, accounting for approximately 70 to 75% of all hepatitis C infections. Accordingly, treatment of genotype 1 has the most extensive data and highest clinical relevance for hepatitis C treatment issues in the United States. Genotype 1 infection has been historically difficult to treat, but multiple recent studies have shown SVR rates greater than 90% in these genotype 1 patients using well-tolerated, all-oral regimens consisting of new direct-acting antiviral agents. The use of these direct-acting antiviral agents has been complicated by the high price of therapy. For example, the cost of preferred regimens as recommended in the 2016 American Association for the Study of Liver Diseases and Infectious Diseases Society of America (AASLD/IDSA) guidance for treatment-naive and treatment-experienced patients with genotype 1 HCV infection ranges from approximately $55,000 to $147,000, including patients with or without compensated cirrhosis (Figure 1). The following discussion regarding initial treatment and retreatment of patients with genotype 1a or 1b chronic hepatitis C assumes the patient and their clinician have already made the decision to initiate hepatitis C therapy.
Medications used to Treat Hepatitis C: The HCV Medications section on this web site provides detailed information for each of the FDA-approved medications listed in the treatment recommendations, including links to the full prescribing information and to patient assistance programs. Adherence with the treatment regimen is of paramount importance. Patients should receive detailed counseling regarding the importance of adherence prior to starting therapy as well as intensive monitoring and follow-up during therapy.