What are the recommended treatment regimens for chronic Hepatitis C in adults?

Direct-acting antivirals (DAAs) are the first-line treatment for chronic hepatitis C virus (HCV) infection [Ahmad, 2017]. Interferon-based treatment regimens are no longer recommended for HCV infection [Ahmad, 2017].

DAAs are typically administered as a once-daily oral tablet regimen for either 8 or 12 weeks [PHE, 2018a]. This treatment is most effective when given before the onset of cirrhosis [PHE, 2018a]. The National Institute for Health and Care Excellence (NICE) has approved the use of DAAs, alone or in certain combinations, for the treatment of different genotypes of chronic HCV infection ¹.

Examples of approved DAA regimens include:

• Sofosbuvir ¹
• Ledipasvir-sofosbuvir ¹
• Ombitasvir-paritaprevir-ritonavir with or without dasabuvir ¹
• Elbasvir–grazoprevir ¹
• Sofosbuvir-velpatasvir ¹
• Glecaprevir–pibrentasvir ¹
• Sofosbuvir-velpatasvir-voxilaprevir ¹

All people with chronic HCV infection should be considered for antiviral therapy, which is always initiated by a specialist [Ahmad, 2017; BMJ, 2019; SIGN, 2013]. The specific treatment regimen and its duration depend on several factors, including the HCV genotype, viral load, severity of liver disease, prior HCV treatment history, the presence of comorbidities, and the person's ability to tolerate treatment [BASHH, 2017a].

The primary goal of treatment is to eradicate the virus, achieve a sustained virological response (SVR), and prevent disease progression [Ahmad, 2017; BMJ, 2019]. SVR, defined as undetectable HCV RNA in the blood 12 weeks after treatment completion, is considered equivalent to a cure [PHE, 2018a; WHO, 2018].