Direct-acting antiviral agents

The DAA agents target multiple steps in the HCV replication life cycle, are highly effective and 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 TGA in Australia, including the NS3 protease inhibitors glecaprevir, grazoprevir and voxilaprevir; the NS5B nucleotide inhibitor sofosbuvir; and the NS5A inhibitors velpatasvir, pibrentasvir, elbasvir and ledipasvir. 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.

Pan-genotypic regimens are recommended as first-line treatment for people with chronic hepatitis C infection (see Pangenoptypic regimens for chronic infection with genotypes 1-6). Several genotype-specific regimens for the treatment of HCV infection have previously been available for the treatment of hepatitis C but are no longer marketed in Australia and have been removed from this con­sensus statement. These include elbasvir plus grazoprevir; sofosbuvir plus ledipasvir; sofosbuvir plus daclatasvir, with or without ribavirin; sofosbuvir plus ribavirin; and paritaprevir (ritonavir-boosted) plus ombitasvir plus dasabuvir, with or without ribavirin.