Retreatment in Persons With Decompensated Cirrhosis

Recommended Regimens 

Retreatment of people with decompensated cirrhosis who have experienced direct-acting antiviral (DAA) treatment failure is limited by the inability to use an NS3/4 protease inhibitor in the setting of decompensated cirrhosis. Recommendations to retreat with either sofosbuvir (400 mg)/velpatasvir (100 mg) plus weight-based ribavirin, or ledipasvir (90 mg)/sofosbuvir (400 mg) plus weight-based ribavirin for 24 weeks are based on relatively favorable SVR rates with these regimens among persons with compensated cirrhosis and prior DAA treatment failure (Gane, 2017); (Wyles, 2015b); (Osinusi, 2014).  

Sofosbuvir/velpatasvir/voxilaprevir is not currently recommended for persons with decompensated cirrhosis in the context of very limited data. One small retrospective study reported that among 6 persons with decompensated cirrhosis and prior DAA treatment failure who underwent retreatment with sofosbuvir/velpatasvir/voxilaprevir, 83% (5/6) attained SVR (Patel, 2021). 

For additional information, see the Persons With Decompensated Cirrhosis section.