Eight Weeks of Pills Cleared Hepatitis C as Often as Twelve
An Indian trial in The Lancet found eight weeks of sofosbuvir-velpatasvir cleared hepatitis C in 98.8 percent of patients without cirrhosis, matching twelve weeks. Guidelines have not changed.
Dr Rakesh Aggarwal's trial kept the people with cirrhosis out, on purpose
Dr Rakesh Aggarwal has spent years watching a cure that people do not finish. Sofosbuvir and velpatasvir, taken together, clear hepatitis C in most patients who complete twelve weeks. In India the market course costs about 15,000 rupees. The virus is quiet for years before it scars a liver. Nearly one in 200 people in the country is infected. The ones who quit early are not a rounding error.
On 30 September 2026 The Lancet published RESOLVE, an Indian Council of Medical Research trial Aggarwal led. Indian Express put him on the record on 13 October. The trial enrolled 880 treatment-naive adults without cirrhosis at five public hospitals: two in Lucknow, two in New Delhi, one in Varanasi. Median age was 35. Just over half were women. 443 were assigned eight weeks. 437 were assigned the standard twelve.
Among people who finished the pills and came back for the test twelve weeks later, 410 of 415 in the short arm cleared the virus, 98.8 percent. In the long arm it was 397 of 401, 99.0 percent. The difference was 0.2 percentage points. On the stricter intention-to-treat count, which keeps the people who never came back, the short arm was 93.5 percent and the long arm 91.8 percent. No one had a drug-related serious adverse event or stopped because of one.
Aggarwal told Indian Express the shorter course was not less effective inside a pre-set statistical margin. He said a one-third cut in drug cost is about 5,000 rupees a patient at market prices, and that government procurement prices are not public, so the saving inside the national program may differ. He also said shorter courses for tuberculosis and leprosy improved completion, and that this trial did not itself prove the same for hepatitis C. That benefit is expected, not measured.
The findings cover a large share of the more than 50 million people worldwide, including nearly six million in India, who need treatment and do not yet have cirrhosis. People with HIV, and people who inject drugs, were not in the trial. Aggarwal said he sees no clear reason to withhold eight weeks from people who use drugs, and that twelve weeks may still be safer for HIV co-infection. National and international guidelines have not changed. Companies have little commercial reason to ask regulators to shorten a course they already sell. Physicians sometimes adopt evidence off-label anyway. His team has ICMR funding to test whether people with cirrhosis, who usually take 24 weeks, can stop at 12. That trial has not started.
Key Facts
- Lancet: 30 September 2026. Indian Express interview: 13 October 2026
- RESOLVE: 880 adults, five public hospitals, no cirrhosis, no prior treatment
- Per protocol: 98.8 percent SVR12 at eight weeks (410/415) versus 99.0 percent at twelve (397/401)
- Intention to treat: 93.5 percent versus 91.8 percent
- No drug-related serious adverse event
- About 5,000 rupees a patient at market prices if the course drops by a third
- About 50 million people worldwide still need treatment, nearly six million in India
- Sources: The Lancet, Indian Express, Times of India
Why This Matters
A cure that takes four fewer weeks is not a new molecule. It is a budget and a bus fare. Public hospitals in Lucknow and Varanasi do not get extra patients by press release. They get them if the course is short enough to finish. The percentage is allowed only after the trial design, and only with the cirrhosis exclusion attached.
What We Don't Know Yet
Guidelines have not moved. Cirrhosis was excluded because failure is more dangerous when the liver has less reserve. HIV co-infection was excluded. Government purchase prices are unpublished, so the rupee saving inside the national program is an estimate. A shorter course that is not adopted is a PDF.