Current DAA combinations

Current single DAAs and fixed dose combination (FDC) tablets are listed in Table 2 below.

Table 2. DAAs, genotypes and NICE comments (2024) *

Regimen and drug classes	Genotypes	Duration	Contraindications and ART interactions
Elbasvir/grazoprevir (NS5A inhibitor/protease inhibitor)	G1 & 4	8 weeks (no cirrhosis) 12 weeks (compensated cirrhosis).	People with decompensated cirrhosis (CPT class B and C). Cannot be used with HIV protease inhibitors, efavirenz, nevirapine and etravirine, fostemsavir, elvitegatvir/c.
Sofosbuvir/ledipasvir (NS5B inhibitor/NS5A inhibitor), with or without ribavirin (RBV*)	G1,4,5 & 6	8-12 weeks (no cirrhosis) & 12 weeks with RBV for G5 & G6, and for compensated and decompensated cirrhosis).	* See: cautions and side effects with RBV. Interactions with lopinavir/r; monitor renal function if used with tenofovir.
Glecaprevir/pibrentasvir (NS5A inhibitor/protease inhibitor)	All	8 weeks (no cirrhosis) or 8-12 weeks (compensated cirrhosis).	People with decompensated cirrhosis (CPT class B and C). Cannot be used with HIV protease inhibitors, efavirenz, nevirapine and etravirine.
Sofosbuvir/velpatasvir (NS5B inhibitor/NS5A inhibitor), with or without ribavirin (RBV*)	All	12 weeks (no cirrhosis and compensated cirrhosis); 12 weeks plus RBV (for G3 and compensated and all genotypes with decompensated cirrhosis).	* See: cautions and side effects with RBV. Interactions with efavirenz, etravirine nevirapine; monitor renal function if used with tenofovir
Sofosbuvir/velpatasvir/voxilaprevir (NS5B + NS5A + protease inhibitor)	All	12 weeks.	People with decompendated cirrhosis. Interactions with boosted atazanivir, boosted darunavir lopinavir/r, fostemsavir, monitor renal function if used with tenofovir

* Ribavirin (RBV) can cause anemia (low red blood cell count), nausea, diarrhea, rash, fatigue, headache, itching, insomnia irratibility, deoression and suicidial thoughts; it cannot be used by people with sickle cell disease, thalassemia, or serious heart disease. RBV causes birth defects and should not be used by any partner planning a pregnancy during treatment and for 6 months after.

Source: EACS Guidelines, V 12.1 2024.
https://www.eacsociety.org/guidelines/eacs-guidelines

For interactions between DAAs and other medicines:
https://hep-druginteractions.org/checker

Introduction to DAAs

DAA stands for direct-acting antivirals. These drugs target HCV.

DAAs cure more than 95% of people, usually from one or two pills a day for 12 weeks (but sometimes for longer).

So in an ideal world, the next step after finding out you have HCV should just be a short course of treatment. No extra monitoring or testing, just treatment and cure.

However, the high prices charged for DAAs means that access to treatment is limited for most people globally, including some people in the UK.

How well does treatment work?

The high cure rates (more than 95%) shows that DAAs are effective enough to treat nearly everyone.

Even in people with cirrhosis, although cure rates are lower, they are still around 80%.

Different DAA classes

As with HIV drugs, each class of DAA works at a different stage of the HCV life cycle.

These classes are:

HCV protease inhibitors (PIs).
Non-nucleoside, nucleoside and nucleotide polymerase inhibitors.
NS5A inhibitors.

DAAs are used in combinations, sometimes with ribavirin (RBV).

Adherence is very important with DAAs. This is defined as taking more than 95% of doses on time.

Currently approved DAAs

Current DAAs and fixed dose combinations are listed below with links to the EMA website for information on each one:

daclatasvir 30, 60, and 90 mg (Daklinza)
dasabuvir 250 mg (Exviera)
sofosbuvir / ledispavir 400 mg / 90 mg (Harvoni)
simepravir 150 mg (Olysio) [now rarely used]
sofosbuvir 400 mg (Sovaldi)
sofosbuvir/velpatasvir 400 mg / 100 mg (Epclusa)
ombitasvir / paritaprevir / ritonavir 2.5 mg / 75 mg / 50 mg (Viekirax in the EU, Technivie in the US). [Ombitasvir/paritaprevir/ritonavir with dasabuvir is marketed as Vieira PAK or Viekira ER, depending on the formulation].
elbasvir / grazoprevir 50 mg /100 mg (Zepatier)

The next pages include the goals of treatment, choice of drugs, duration of treatment, who should use treatment, how effectiveness is measured and whether HIV or HCV should be treated first.

Deciding whether to use treatment is also discussed in detail.

Managing HCV with lifestyle changes that help your liver are covered later in the section Living with coinfection.

Last updated: 1 November 2024.