First-Line Treatment for Confirmed Hepatitis C Infection

Recommended First-Line Regimens

The American Association for the Study of Liver Diseases recommends sofosbuvir/velpatasvir 400mg/100mg once daily for 12 weeks as the preferred first-line option for all HCV genotypes, achieving SVR rates of 98% 1, 2, 3
The European Association for the Study of the Liver suggests glecaprevir/pibrentasvir for 8 weeks (without cirrhosis) or 12 weeks (with compensated cirrhosis) as an equally effective alternative 1, 2, 3

For patients with compensated cirrhosis, the American Association for the Study of Liver Diseases recommends using the same pangenotypic regimens as non-cirrhotic patients, with glecaprevir/pibrentasvir duration extended to 12 weeks 1, 2, 3
The American Association for the Study of Liver Diseases advises continuing HCC surveillance with ultrasound every 6 months indefinitely, even after achieving SVR, for patients with cirrhosis 1, 2, 3

The European Association for the Study of the Liver recommends HCV genotype and subtype determination before initiating therapy, as genotype 1a vs 1b affects treatment selection 6, 5
The American Association for the Study of Liver Diseases suggests fibrosis staging using noninvasive methods or liver biopsy to determine treatment urgency and duration 4, 5

The American Association for the Study of Liver Diseases warns against using DAAs with P-gp inducers or moderate-to-strong CYP inducers, as they significantly decrease DAA concentrations and reduce efficacy 5

The American Association for the Study of Liver Diseases recommends measuring HCV RNA at baseline, weeks 4 and 12 during treatment, end of treatment, and 12 weeks post-treatment, with SVR12 defining cure 1
The European Association for the Study of the Liver advises patients with cirrhosis to require lifelong HCC surveillance with ultrasound every 6 months, even after achieving SVR 1, 2, 3

The American Association for the Study of Liver Diseases cautions against deferring treatment in patients with advanced fibrosis (F3-F4), as these patients have the most urgent need and greatest short-term benefit from viral eradication 5
The European Association for the Study of the Liver warns against using genotype 1a-specific regimens without confirming subtype, as genotype 1 that cannot be subtyped should be treated as 1a 4
The American Association for the Study of Liver Diseases emphasizes the importance of verifying drug-drug interactions before prescribing, particularly with antiretrovirals, cardiac medications, and acid-suppressing agents 1, 3