Direct-acting antiviral agents (DAAs)
DAA agents that target multiple steps in the HCV replication life cycle have been developed and are highly effective, safe and require a short treatment duration. Virtually all patients are suitable for DAA therapy, including those previously intolerant of or ineligible for IFN therapy. Multiple DAAs have been approved by the Therapeutic Goods Administration (TGA) in Australia, including the NS3 protease inhibitors paritaprevir (ritonavir-boosted) and grazoprevir; the NS5B nucleotide inhibitor sofosbuvir; the NS5B non-nucleotide inhibitor dasabuvir; and the NS5A inhibitors ledipasvir, ombitasvir, daclatasvir and elbasvir. Several IFN-free regimens combining these DAAs have been PBS-listed for the treatment of people with HCV infection, including people with compensated and decompensated liver disease.
There is one pan-genotypic DAA regimen listed on the PBS — sofosbuvir plus velpatasvir — which is the most recent regimen to become available, being listed on the PBS on 1 August 2017. The other DAA regimens are all genotype-specific, and each genotype will be considered individually here. The treatment for HCV will continue to evolve, and this consensus statement will be updated as new data emerge.