Chronic hepatitis C
ICD-10 B18.2 · ICD-11 1E51.1

First-Line Treatment of Chronic Hepatitis C in Treatment-Naive Adults (Age ≥18), With or Without Compensated Cirrhosis

This protocol addresses adults aged 18 years and older with chronic hepatitis C infection of any genotype who have not previously received HCV treatment — including persons living with HIV — and who are without cirrhosis or have only compensated cirrhosis.

Who This Protocol Applies To

Treatment Goal Sustained virologic response 12 weeks after completion of therapy (SVR12) — undetectable HCV RNA.
Treatment Approach — Partial Overview Recommended treatment uses oral direct-acting antiviral (DAA) combination regimens; the optimal choice and course are guided by HCV genotype and cirrhosis status. The full regimen selection — including all options, genotype-specific considerations, and any additional agents — is detailed in the structured protocol below.
Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/cid/ciad319

Adults with chronic HCV infection, including persons living with HIV:

Have not previously received HCV treatment

Without cirrhosis or with compensated cirrhosis (Child-Pugh A) as determined by:

The HCV guidance first introduced the simplified treatment algorithms for treatment-naive persons (without cirrhosis or with compensated cirrhosis) in 2019.

Recommended DAA regimens for this simplified treatment approach include either 8 weeks of glecaprevir (300 mg)/pibrentasvir (120 mg) taken with food or 12 weeks of sofosbuvir (400 mg)/velpatasvir (100 mg).

For genotype 3 infection with compensated cirrhosis, NS5A RAS testing is recommended. If baseline NS5A RAS Y93H is present, add weight-based ribavirin or choose another recommended regimen.

Applicable to patients without cirrhosis who are not living with human immunodeficiency virus and whose HCV RNA is <6 million IU/mL.

SVR12, sustained virologic response 12 weeks after completion of therapy.

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