Hepatitis C Treatment Guidelines

Introduction to Hepatitis C Treatment

The American Association for the Study of Liver Diseases recommends a pangenotypic direct-acting antiviral (DAA) regimen consisting of either sofosbuvir/velpatasvir for 12 weeks or glecaprevir/pibrentasvir for 8-12 weeks, depending on cirrhosis status and treatment history 1, 2

For genotype 1a patients without cirrhosis, the European Association for the Study of the Liver recommends daily fixed-dose combination of ledipasvir (90 mg)/sofosbuvir (400 mg) for 12 weeks or daily sofosbuvir (400 mg) plus simeprevir (150 mg) for 12 weeks (if Q80K variant negative) 3
For genotype 1b patients without cirrhosis, the American Association for the Study of Liver Diseases recommends daily fixed-dose combination of ledipasvir (90 mg)/sofosbuvir (400 mg) for 12 weeks or daily fixed-dose combination of paritaprevir/ritonavir/ombitasvir plus dasabuvir for 12 weeks 3
For genotype 2 patients, the European Association for the Study of the Liver recommends sofosbuvir/velpatasvir for 12 weeks without ribavirin 5
For genotype 3 patients, the American Association for the Study of Liver Diseases recommends sofosbuvir/velpatasvir for 12 weeks (treatment-naïve without cirrhosis) or sofosbuvir/velpatasvir plus ribavirin for 12 weeks (treatment-experienced or with cirrhosis) 6
For genotype 4, 5, and 6 patients, the European Association for the Study of the Liver recommends sofosbuvir/velpatasvir for 12 weeks without ribavirin 6

For patients without cirrhosis, the American Association for the Study of Liver Diseases recommends glecaprevir/pibrentasvir for 8 weeks 7, 2
For patients with compensated cirrhosis, the European Association for the Study of the Liver recommends glecaprevir/pibrentasvir for 12 weeks 7, 2
For patients with decompensated cirrhosis, the American Association for the Study of Liver Diseases recommends sofosbuvir/velpatasvir plus ribavirin for 12 weeks 2

For HIV-coinfected patients, the American Association for the Study of Liver Diseases recommends the same HCV treatment regimens as in patients without HIV infection, with dose adjustments needed in case of interactions with antiretroviral drugs 1, 2
For liver transplant recipients, the European Association for the Study of the Liver does not provide specific recommendations, but sofosbuvir/velpatasvir once daily for 12 weeks may be considered

The American Association for the Study of Liver Diseases recommends monitoring HCV RNA levels at baseline, during treatment, at the end of treatment, and 12 weeks after completion to assess SVR 2
For patients with cirrhosis, the American Association for the Study of Liver Diseases recommends continuing monitoring for hepatocellular carcinoma with ultrasound every 6 months, even after achieving SVR 1, 2

The American Association for the Study of Liver Diseases recommends carefully evaluating drug-drug interactions before initiating DAA therapy, particularly in patients on multiple medications 2
The European Association for the Study of the Liver recommends using one of the other recommended regimens in patients with HCV genotype 1a who have the NS3 Q80K polymorphism, as they have lower SVR rates with sofosbuvir and simeprevir 3