In an individual who is HCV antibody-positive, current HCV infection should be confirmed by a PCR assay for HCV RNA. Quantitative PCR may be considered as part of the pre-treatment assessment because HCV RNA level can identify people who are eligible for a short treatment duration with sofosbuvir plus ledipasvir (see Treatment for chronic hepatitis C).
We continue to recommend HCV genotyping as part of the pre-treatment assessment. HCV genotype is required by the PBS criteria.
Elbasvir plus grazoprevir and sofosbuvir plus ledipasvir are both genotype-specific treatment regimens, and HCV genotype should be determined before prescribing either regimen.
We acknowledge that HCV genotype does not change management when prescribing sofosbuvir plus velpatasvir or glecaprevir plus pibrentasvir for treatment-naive people with no cirrhosis. However, even for these regimens, HCV genotype can provide clinically relevant information.
HCV genotype is relevant to decision making regarding sofosbuvir plus velpatasvir for people with cirrhosis, and for glecaprevir plus pibrentasvir in people who are treatment-experienced (see Treatment for chronic hepatitis C).
HCV genotype may also be useful information for people with a high risk of reinfection, where genotype switch can differentiate reinfection from relapse. HCV genotyping is now a routine laboratory test and is a reimbursed test on the Medicare Benefits Schedule (MBS).
It is important to document any prior treatment for HCV infection. Key information includes treatment regimen, duration, adherence and response. These may influence the choice of treatment regimen and/or treatment duration (see Treatment for chronic hepatitis C). Patients in whom a previous IFN-free regimen has failed frequently have resistant HCV variants.