Who needs HCV treatment?

HIV positive people with HCV coinfection should be offered DAA treatment.

But although HCV guidelines recommend everyone should be treated, access to DAAs is prioritised for people with more advanced liver fibrosis.

Since February 2017, DAAs are recommended in the UK for all genotypes. No-one should need to use the old HCV treatment with pegylated interferon (PEG-IFN) and ribavirin (RBV).

How urgently you need treatment will depend on several factors.

These factors include:

Whether HCV is acute or chronic.

HCV genotype can be a factor in deciding when to treat and when to wait.

How you feel about the urgency of treatment.

How you feel about the risk of onward transmission.

The amount of liver damage:

Mild liver disease does not need immediate treatment. This makes it easier if you decide to wait for DAAs. Regular monitoring to assess fibrosis progression is important.

Moderate liver damage has a higher risk of progression to cirrhosis and a greater need for treatment.

Compensated cirrhosis (when the liver is damaged but can still perform)can be treated. DAAs are strongly recommended but careful monitoring is needed.

Decompensated cirrhosis (when damage is so severe that the liver stops working) can be treated with DAAs, but cure rates are lower (50% to above 80%).

Referral to a liver specialist is essential. The consultation should be about treatment, liver transplant and management of complications.