| Universal treatment | All hepatitis C virus (HCV) RNA-positive individuals, regardless of the presence of liver cirrhosis, concurrent chronic kidney disease, or extrahepatic manifestations, should receive antiviral therapy. |
| Treating the high-risk populations | Patients with advanced liver fibrosis or cirrhosis, significant extrahepatic manifestations, HCV recurrence after liver transplantation, and those at high risk of accelerating liver disease progression should be prioritized for immediate treatment. |
| Pre-treatment assessment | Before initiating antiviral treatment, assess the severity of liver disease, kidney function, HCV RNA quantification, hepatitis B surface antigen (HBsAg) and hepatitis B virus (HBV) core antibody status, comorbidities, and concomitant medication use. HCV genotyping may be necessary in some cases. |
| Monitoring during treatment | Monitor treatment efficacy and safety throughout the course of therapy. Patients receiving direct-acting antivirals (DAAs) should undergo clinical adverse event assessments at each visit. Alanine aminotransferase (ALT) levels should be monitored at baseline, at weeks 4, 12, and 24 of treatment, or as clinically indicated. |
| Treatment endpoint | The treatment endpoint is sustained virologic response after 12 weeks of ending antiviral therapy (SVR12). This is achieved when sensitive detection methods (with a lower limit of detection ≤ 15 IU/mL) show that HCV RNA is undetectable. |
| Retreatment of previous failures | For patients with prior antiviral treatment failures, it is crucial to ascertain the previous treatment regimen, the clinical type of treatment failure (non-response, relapse, or breakthrough), and the presence of cirrhosis. The selection of a DAA combination regimen should avoid targeting the same viral points as previous treatments, based on drug availability and DAA target differences. |
