Initial Treatment of HCV Infection

Initial treatment of HCV infection includes patients with chronic hepatitis C who have not been previously treated with IFN, PEG-IFN, ribavirin, or any HCV direct-acting antiviral (DAA) agent, whether experimental, investigational, or US Food and Drug Administration (FDA) approved.

The level of evidence available to inform the best regimen for each patient and the strength of the recommendation vary, and are rated accordingly (see Methods Table 2). In addition, specific recommendations are given when treatment differs for a particular group (eg, those infected with various genotypes). Recommended regimens are those that are favored for most patients in that subgroup, based on optimal efficacy, favorable tolerability and toxicity profiles, and duration. Alternative regimens are those that are effective but have, relative to Recommended regimens, potential disadvantages, limitations for use in certain patient populations, or less supporting data than Recommended regimens. In certain situations, an Alternative regimen may be an optimal regimen for a specific patient situation. Not Recommended regimens are clearly inferior compared to Recommended or Alternative regimens due to factors such as lower efficacy, unfavorable tolerability and toxicity, longer duration, and/or higher pill burden. Unless otherwise indicated, such regimens should not be administered to patients with HCV infection. Specific considerations of persons with HIV/HCV coinfection, decompensated cirrhosis (moderate or severe hepatic impairment; Child Turcotte Pugh [CTP] class B or C), HCV infection post-liver transplant, and those with severe renal impairment or end-stage renal disease (ESRD) are addressed in other sections of the Guidance.

Recommended and Alternative regimens are listed in order of level of evidence. When several regimens are offered at the same recommendation level, they are listed in alphabetical order. Choice of regimen should be determined based on patient-specific data, including drug interactions. As always, patients receiving antiviral therapy require careful pretreatment assessment for comorbidities that may influence treatment response. All patients should have careful monitoring during treatment, particularly for anemia if ribavirin is included in the regimen (see Monitoring section).

The following pages include guidance for management of treatment-naive patients.

Last update: 
April 12, 2017