Approach to therapy

The factors affecting choice and duration of therapy include the prior treatment history, presence or absence of cirrhosis or liver decompensation, potential drug interactions, comorbidities including HIV infection, and HCV genotype and subtype in some circumstances (eg if a genotype-specific direct-acting antiviral is required, or in people at high risk for reinfection, when a change in HCV genotype can differentiate reinfection from relapse). See Assessment before starting treatment for hepatitis C for more detail.

Drug recommendations for hepatitis C in adults are provided below for the following groups:

In patients with cirrhosis, treatment should be started as early as possible.

Summary of pangenotypic direct-acting antiviral regimens for adults with hepatitis C provides a summary of the commonly used direct-acting antiviral therapy regimens for adults with hepatitis C in Australia.

There is currently no approved therapy for postexposure prophylaxis for hepatitis C infection. For more information, see Postexposure prophylaxis against bloodborne viruses.

For more detailed information about treatment of hepatitis C, see the Australian recommendations for the management of hepatitis C virus infection: A consensus statement, available online, which includes detailed advice for special populations such as patients with decompensated liver disease, hepatitis B or HIV co-infection, kidney impairment and treatment after liver transplantation.

Table 1. Summary of pangenotypic direct-acting antiviral regimens for adults with hepatitis C
[NB1]
Drug combination (brand name example)	Number of tablets daily	Duration of therapy — without cirrhosis	Duration of therapy — with cirrhosis
First-line therapy options for treatment-naive adults
glecaprevir + pibrentasvir 100+40 mg (Maviret)	3 tablets once daily (in a single dose)	8 weeks	8 weeks [NB2]
sofosbuvir + velpatasvir 400+100 mg (Epclusa)	1 tablet daily	12 weeks	12 weeks
Treatment of adults who are not cured with first-line therapy due to virological failure
sofosbuvir + velpatasvir + voxilaprevir 400+100+100 mg (Vosevi)	1 tablet daily	12 weeks	12 weeks
Note: . NB1: These drug regimens are not suitable for patients with decompensated liver disease; for information about this group, see here NB2: A treatment duration of 12 weeks may be considered for patients with compensated cirrhosis at the discretion of the prescriber.