Hepatitis C Treatment Pathway

Test → treat → cure. Any Australian GP or nurse practitioner can prescribe pan-genotypic direct-acting antivirals (DAAs) for hepatitis C — no genotype required, no specialist sign-off needed for uncomplicated cases. This tool walks the workflow and suggests the regimen.

📋 Sources: Australian recommendations for the management of hepatitis C virus infection: a consensus statement (Gastroenterological Society of Australia); RACGP — Treating chronic hepatitis C in general practice; ASHM — Decision Making in Hepatitis C; National HCV Testing Policy. PBS regimen criteria current to June 2026 — verify the current PBS Schedule before prescribing. Verified June 2026.
Educational reference for clinicians, not patient-specific advice. Use clinical judgement; complex cases (cirrhosis, prior DAA failure, decompensation, co-infection) need specialist input or REACH-C consultation.

⚠ Use clinical judgement. This tool assumes treatment-naive, uncomplicated chronic HCV. Cirrhosis, prior DAA treatment failure, decompensated liver disease, pregnancy, significant drug interactions, and HBV/HIV co-infection all change the pathway — these need specialist or REACH-C input. Always run a drug-interaction check before prescribing (sofosbuvir and the protease inhibitors interact with several common medicines).

Step-by-step pathway

The two first-line regimens

Both are pan-genotypic — genotype testing is no longer required for PBS. Either is suitable first-line for treatment-naive patients.

Glecaprevir / pibrentasvir (Maviret) 3 tablets once daily with food. 8 weeks treatment-naive (with or without compensated cirrhosis). No renal dose adjustment. Contraindicated in decompensated cirrhosis (Child–Pugh B/C) — it's a protease inhibitor. Common SE: headache, fatigue, nausea.

Sofosbuvir / velpatasvir (Epclusa) 1 tablet once daily. 12 weeks (with or without cirrhosis). No renal dose adjustment. Safe in decompensated cirrhosis (preferred when decompensation present, usually with specialist input). Consider adding ribavirin in genotype-3 with compensated cirrhosis. Common SE: headache, fatigue, nausea.

Salvage (NS5A-experienced / prior DAA failure): sofosbuvir/velpatasvir/voxilaprevir (Vosevi) for 12 weeks — usually specialist-directed.

Pre-treatment work-up (one round of bloods)

HCV RNA (quantitative) — confirms current infection. Genotype NOT required for PBS.
FBC, LFTs, U&E, INR — baseline; needed for APRI / FIB-4.
Cirrhosis assessment — FibroScan, or APRI / FIB-4 from FBC + LFTs. If you can't assess fibrosis promptly, start treatment anyway (don't delay) — but flag for fibrosis assessment.
HBV serology (HBsAg, anti-HBc, anti-HBs) — HBV reactivation risk during DAA therapy; check before or within 4 weeks of starting.
HIV serology — co-infection alters management.
Pregnancy test if relevant — ribavirin is teratogenic; DAAs not recommended in pregnancy.
Drug interaction check — review all concomitant medicines (statins, amiodarone, anticonvulsants, PPIs with some regimens, St John's Wort).

Confirming cure — SVR12

SVR12 = sustained virological response. Check HCV RNA at least 12 weeks after completing treatment. Undetectable RNA = cure (≥95% with pan-genotypic DAAs in primary care). Document the cure, counsel that cure does not confer immunity (re-infection is possible with ongoing risk), and offer harm-reduction. If RNA is still detectable → treatment failure; refer for resistance testing and salvage (Vosevi).

When to involve a specialist or REACH-C

Any GP can treat uncomplicated HCV. Seek specialist or REACH-C input for:

Cirrhosis (especially decompensated — Child–Pugh B/C)
Prior DAA treatment failure
HBV or HIV co-infection
Significant renal impairment or complex drug interactions
Pregnancy, or current/planned pregnancy
Hepatocellular carcinoma, or current/prior
You are not experienced in HCV treatment (consensus statement: practitioners not experienced should consult an experienced specialist before initiating)

REACH-C provides specialist approval, typically within 24 hours, via an online form — a time-efficient option for GPs newer to HCV treatment. ashm.org.au/resources/reach-c