Direct-acting antiviral agents

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 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.

There are now three pan-genotypic DAA regimens listed on the PBS: sofosbuvir plus velpatasvir, glecaprevir plus pibrentasvir, and sofosbuvir plus velpatasvir plus voxilaprevir. Other DAA regimens are all genotype-specific, and each genotype will be considered individually here (Tables 3 and 4). The treatment for HCV will continue to evolve, and this consensus statement will be updated as new data emerge.