Dual sofosbuvir and ribavirin therapy for chronic hepatitis C infection

Expert Rev Gastroenterol Hepatol. 2016;10(1):21-36. doi: 10.1586/17474124.2016.1119042. Epub 2015 Dec 11.


Sofosbuvir is the first pan-genotypic direct acting antiviral agent to be approved. This article provides an overview of the pharmacology of sofosbuvir and ribavirin and a comprehensive summary of the phase 2 and 3 studies supporting dual sofosbuvir and ribavirin therapy for chronic hepatitis C infection. With the production of generic formulations of sofosbuvir, we anticipate this regimen leading the first wave for widespread, IFN-free treatment and becoming first line for all genotypes (including genotype 1) for much of the world-in particular in developing and middle income countries. We discuss the continued challenges with this regimen including among patients with decompensated liver disease and post-liver transplant, and renal failure. We address concerns of emerging resistance. We also discuss the future prospects including the global uptake of sofosbuvir and ribavirin for the treatment of all genotypes.

Keywords: HIV co-infection; Sofosbuvir; direct acting antivirals (DAA); genotype 1; genotype 2; genotype 3; genotype 4; hepatitis C; pegylated interferon; ribavirin.

Publication types

  • Review

MeSH terms

  • Antiviral Agents / therapeutic use*
  • Clinical Trials, Phase II as Topic
  • Clinical Trials, Phase III as Topic
  • Drug Resistance, Viral
  • Drug Therapy, Combination
  • Genotype
  • Hepacivirus / genetics*
  • Hepatitis C, Chronic / complications
  • Hepatitis C, Chronic / drug therapy*
  • Humans
  • Liver Cirrhosis / surgery
  • Liver Cirrhosis / virology
  • Liver Failure / surgery
  • Liver Failure / virology
  • Liver Transplantation
  • Recurrence
  • Renal Insufficiency / complications
  • Ribavirin / pharmacology
  • Ribavirin / therapeutic use*
  • Sofosbuvir / pharmacology
  • Sofosbuvir / therapeutic use*


  • Antiviral Agents
  • Ribavirin
  • Sofosbuvir