Sofosbuvir is one of the new direct-acting antiviral drugs that target different steps of the hepatitis C virus (HCV) lifecycle. It is a nucleotide analogue HCV polymerase inhibitor, meaning it blocks the polymerase enzyme which the virus must use to reproduce. Sofosbuvir should be combined with other medications, which may include pegylated interferon (which stimulates the body's own immune response), ribavirin or other direct-acting antivirals that work differently.
Sofosbuvir is indicated for use by adults with chronic hepatitis C, meaning infection lasting more than six months. It is approved for people with HCV genotype 1, 2, 3, 4, 5 or 6. Genotype 1 is the most common type in Europe and considered the hardest to treat. Sofosbuvir can be used by people being treated for hepatitis C for the first time (known as 'treatment-naive') and for retreatment of people who were not cured with previous interferon-based therapy (known as 'treatment-experienced'). Sofosbuvir has also been tested in people with HIV and HCV co-infection. Response rates and side-effects are similar to those of HIV-negative people, and sofosbuvir does not interact with HIV drugs. People with co-infection who want to take sofosbuvir should do so under the care of a doctor who has experience treating both infections. Sofosbuvir can be used by people with all stages of liver disease including compensated and decompensated cirrhosis. However, it works better for people with less advanced liver damage. Data on safety and efficacy in decompensated cirrhosis have not yet been published. People with chronic hepatitis C who are awaiting or have received a liver transplant tolerate sofosbuvir better than older medications.
The following indications for sofosbuvir relate to patients with chronic hepatitis C virus infection.
Sofosbuvir is indicated for treatment of patients with chronic HCV
For patents with genotype 1 HCV who are not eligible to receive interferon: sofosbuvir plus ribavirin for 24 weeks can be considered.
For patients with HCV and hepatocellular carcinoma awaiting liver transplantation: sofosbuvir plus ribavirin for a duration of up to 48 weeks or until liver transplantation, whichever occurs first.