Consensus recommendations

Consensus recommendations

Grade

All individuals with chronic HCV infection should be considered for antiviral therapy.

A1

Choice of treatment regimen should be based on:

  • HCV genotype and subtype
  • the presence or absence of cirrhosis
  • the presence or absence of liver decompensation
  • prior treatment history
  • the potential for drug–drug interactions
  • comorbidities

Women of childbearing potential should be cautioned to avoid pregnancy while receiving DAA treatment. 
Men and women of childbearing potential should be cautioned to avoid pregnancy while receiving ribavirin-containing antiviral regimens and for up to 6 months after stopping. 
Breastfeeding women should not be treated with DAAs.

B1

A1

B1

People who are treatment-naive (see Table 2)

First-line treatment regimens that are pan-genotypic include:

  • sofosbuvir + velpatasvir for 12 weeks
  • glecaprevir + pibrentasvir for 8 or 12 weeks

A1

Recommended treatment regimens for chronic Gt 1 HCV infection and compensated liver disease include:

  • sofosbuvir + velpatasvir for 12 weeks
  • glecaprevir + pibrentasvir for 8 or 12 weeks
  • elbasvir + grazoprevir for 12 weeks
  • sofosbuvir + ledipasvir for 8 or 12 weeks

A1

Recommended treatment regimens for chronic Gt 2 HCV infection and compensated liver disease are:

  • sofosbuvir + velpatasvir for 12 weeks
  • glecaprevir + pibrentasvir for 8 or 12 weeks

A1

Recommended treatment regimens for chronic Gt 3 HCV infection and compensated liver disease include:

  • sofosbuvir + velpatasvir ± ribavirin for 12 weeks
  • glecaprevir + pibrentasvir for 8 or 12 weeks

A1

Recommended treatment regimens for chronic Gt 4 HCV infection and compensated liver disease include:

  • sofosbuvir + velpatasvir for 12 weeks
  • glecaprevir + pibrentasvir for 8 or 12 weeks
  • elbasvir + grazoprevir for 12 weeks

A1

Recommended treatment regimens for chronic Gt 5/6 HCV infection and compensated liver disease include:

  • sofosbuvir + velpatasvir for 12 weeks
  • glecaprevir + pibrentasvir for 8 or 12 weeks

A1

People in whom DAA therapy has failed (see Table 3)

People in whom first-line DAA therapy fails should be referred to a specialist centre for consideration of salvage therapy.

B1

The recommended treatment regimen for people with compensated liver disease in whom first-line DAA therapy has failed is:

  • sofosbuvir + velpatasvir + voxilaprevir for 12 weeks

A1

Dose reduction or dose interruption of DAA therapies is not recommended.

A1

Dose reduction of ribavirin for the management of symptomatic anaemia according to the product information is appropriate and will not reduce the likelihood of SVR.

A1

DAA therapies for HCV should not be used in combinations other than those that have demonstrated efficacy in prospective clinical trials.

B1