Hepatitis C Treatment Guidelines

Recommended Treatment Regimens

The European Association for the Study of the Liver 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
Sofosbuvir/velpatasvir (fixed-dose combination of 400 mg sofosbuvir and 100 mg velpatasvir) is recommended in a single tablet administered once daily for 12 weeks 1
Glecaprevir/pibrentasvir (fixed-dose combination of 300 mg glecaprevir and 120 mg pibrentasvir) is recommended in 3 tablets administered once daily with food for 8-12 weeks 1

For genotype 1a, sofosbuvir/velpatasvir for 12 weeks is recommended, with an SVR rate of 98% 4
For genotype 1b, sofosbuvir/velpatasvir for 12 weeks or grazoprevir/elbasvir for 12 weeks are recommended 1, 4
For patients with compensated cirrhosis (Child-Pugh A), an extended duration to 12 weeks for glecaprevir/pibrentasvir may be required 4
For patients with decompensated cirrhosis, sofosbuvir/velpatasvir plus ribavirin for 12 weeks is recommended 3

HCV RNA quantitative testing and genotyping/subtyping should be performed prior to initiating treatment, as recommended by the European Association for the Study of the Liver 5
Assessment of liver disease severity is essential to guide therapy decisions and predict prognosis, according to the European Association for the Study of the Liver 5
Screen for potential drug-drug interactions with all concurrent medications, as recommended by the European Association for the Study of the Liver 2

Monitor HCV RNA levels at baseline, during treatment, at the end of treatment, and 12 weeks after completion to assess SVR, as recommended by the European Association for the Study of the Liver 2
SVR12 (undetectable HCV RNA 12 weeks after treatment completion) represents cure of infection in more than 99% of patients, according to the European Association for the Study of the Liver 2

Modern DAA regimens achieve SVR rates exceeding 95% in most patient populations, as reported by the European Association for the Study of the Liver 1
Successful eradication of HCV (achieving SVR) is associated with improvement in liver histology, decreased risk of cirrhotic complications, reduced occurrence of hepatocellular carcinoma, improved survival rates, and resolution of extrahepatic manifestations, according to the European Association for the Study of the Liver 5
Patients with cirrhosis who achieve SVR still require monitoring as they remain at risk for complications, though at significantly reduced rates, as recommended by the European Association for the Study of the Liver 2

The presence of baseline resistance-associated substitutions (RASs) may affect treatment response and require adjustment of treatment duration or addition of ribavirin, as reported by the European Association for the Study of the Liver 4