Hepatitis C: Treatment

Who can receive new treatment for hepatitis C?

European guidelines issued by the European Association for the Study of the Liver (EASL) updated in 2020 recommend that everyone with hepatitis C should be offered treatment and anyone with liver damage or fibrosis stage 2 (moderate liver damage) or above should receive treatment without delay.

Some combinations of direct-acting antivirals are active against all HCV genotypes. These are called pangenotypic drugs. Other direct-acting antivirals are active against specific genotypes.

Alternative regimens are recommended for genotypes 1b and 3 when drug-drug interactions prevent the use of a pangenotypic regimen. Glecapravir/pibrentasvir and sofosbuvir/velpatasvir are unsuitable for use with some types of anti-HIV drugs and doses of some lipid-lowering, anti-platelet and anti-coagulant drugs may need to be adjusted.

Genotype

Regimen

Special conditions for use

All genotypes

Sofosbuvir/velpatasvir (12 weeks)

Add ribavirin, treat for 12 weeks, in people with decompensated cirrhosis, or 24 weeks without ribavirin

Glecapravir/pibrentasvir (8 weeks)

12 weeks for treatment-experienced people with compensated cirrhosis

Alternative options for specific genotypes

Genotype 1b

Grazoprevir/elbasvir (12 weeks)

 

Genotype 3 (compensated cirrhosis)

Sofosbuvir/velpatasvir/voxilaprevir (12 weeks)

 

Glecapravir/pibrentasvir (8-12 weeks previously untreated)

16 weeks for treatment-experienced people with compensated cirrhosis

Genotype 3 (no cirrhosis)

Sofosbuvir/velpatasvir with ribavirin (12 weeks)

 
 

Glecapravir/pibrentasvir (8 weeks previously untreated)

12 weeks for treatment-experienced people without cirrhosis