13/08/2025
Chronic Hepatitis C Virus (HCV) infection, based on current guideline recommendations:
📌First-Line Treatments (for treatment-naïve patients).
Recommended pangenotypic DAAs (Direct-Acting Antivirals) that offer high cure rates and favorable safety profiles:
1. Sofosbuvir/Velpatasvir (Epclusa)
• Effective across HCV genotypes 1–6, including patients with or without cirrhosis, also those co-infected with HIV.
• Taken as a once-daily oral pill; standard duration: 12 weeks.
• SVR (cure) rates are > 90%, often near 100%. 
2. Glecaprevir/Pibrentasvir (Mavyret)
• Pangenotypic, highly effective for all genotypes.
• 8-week regimen for treatment-naïve patients without cirrhosis; 12 weeks if compensated cirrhosis or other factors present.
• Not suitable for patients with decompensated (CTP B or C) cirrhosis.   
These regimens are the preferred first-line options due to their broad applicability, high efficacy, and simplified dosing.
📌Second-Line / Salvage Treatments
(for failures or specific scenarios)
When primary therapy fails or in special circumstances (e.g., NS5A resistance):
Sofosbuvir/Velpatasvir/Voxilaprevir (Vosevi)
• Triple-combination DAA—a potent option for patients with prior treatment failure (especially to NS5A-containing regimens).
• Indicated for both non-cirrhotic and compensated cirrhotic patients.
• Offers SVR rates of ~96–97% upon retreatment.
• Note: Carries a boxed warning for HBV reactivation, so monitor if co-infected.  
Alternative Treatment According to Genotype
Other regimens like Ledipasvir/Sofosbuvir (Harvoni) or Elbasvir/Grazoprevir (Zepatier) may be considered depending on genotype, prior treatment history, and presence of resistance or cirrhosis—but are generally less favored compared with pangenotypic combinations. 
