sofosbuvir + ledipasvir + ribavirin + peginterferon

This is a four-drug combination regimen consisting of sofosbuvir, ledipasvir, ribavirin, and peginterferon. It is used as an antiviral therapy for chronic hepatitis C virus (HCV) infection. Sofosbuvir is a nucleotide analog NS5B polymerase inhibitor that blocks HCV RNA replication. Ledipasvir is an NS5A inhibitor that interferes with viral replication and assembly. Ribavirin is a nucleoside analog with broad-spectrum antiviral activity, often used to enhance the efficacy of other antivirals in HCV treatment regimens. Peginterferon (pegylated interferon alfa) acts as an immunomodulator by stimulating the host immune response against viral infections. This combination has been studied primarily for patients with chronic HCV genotype 1 or 4 infection, especially those who are treatment-naive or have cirrhosis[5][6]. The addition of ribavirin and peginterferon to sofosbuvir/ledipasvir was more common before the approval of all-oral direct-acting antiviral regimens; it may still be considered in certain difficult-to-treat populations.