Consensus recommendations for the treatment of chronic HCV

Consensus recommendationsGrade
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
A1
First-line treatment regimens for chronic Gt 1 HCV infection and compensated liver disease include (see Table 3):
• sofosbuvir + velpatasvir for 12 weeks
• sofosbuvir + ledipasvir for 8 or 12 or 24 weeks
• elbasvir + grazoprevir ± ribavirin for 12 or 16 weeks
• sofosbuvir + daclatasvir ± ribavirin for 12 or 24 weeks
• paritaprevir–ritonavir + ombitasvir + dasabuvir ± ribavirin for 12 or 24 weeks
A1
The first-line treatment regimen for chronic Gt 2 HCV infection and compensated liver disease is (see Table 4):
• sofosbuvir + velpatasvir for 12 weeks
A1
First-line treatment regimens for chronic Gt 3 HCV infection and compensated liver disease include (see Table 4):
• sofosbuvir + velpatasvir ± ribavirin for 12 weeks
• sofosbuvir + daclatasvir for 12 weeks (no cirrhosis)
• sofosbuvir + daclatasvir ± ribavirin for 12 weeks (cirrhosis) or sofosbuvir + daclatasvir (cirrhosis) for 24 weeks
A1
First-line treatment regimens for chronic Gt 4 HCV infection and compensated liver disease include (see Table 5):
• sofosbuvir + velpatasvir for 12 weeks
• elbasvir + grazoprevir ± ribavirin for 12 or 16 weeks
A1
The current first-line treatment for chronic Gt 5/6 HCV infection and compensated liver disease is (see Table 5):
• sofosbuvir + velpatasvir 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
People in whom first-line DAA therapy fails should be referred to a specialist centre for consideration of salvage therapy.B1

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