Table 1.
French recommendations | EASL recommendations | |
Target audience | National | European, international |
Philosophy | Goal of HCV eradication Maximum simplification of HCV management | State of art |
Screening | Global “Test and treat” | Global “Test and treat” |
Fibrosis | FibroScan®, FibroTest®, FibroMeter® | Enlarged to simple and accessible biological methods, APRI, Fib4 |
RAS screening | Only in case of previous failure to DAA treatment | May be used, in addition and if available, before treatment to optimize some non pangenotypic strategies |
Prescribers | Hepatologists or general practitioners | Hepatologists |
Regimens | Preferably pangenotypic associations sofosbuvir - velpatasvir 12 wk or glecaprevir - pibrentasvir 8 wk if no severe fibrosis | Pangenotypic and no pangenotypic associations according to genotype, viral load, degree of fibrosis, previous treatment, and eventual RAS No sofosbuvir - velpatasvir in case of G3 cirrhotic patients |
In case of failure | RAS screening Only for first generation DAAs failures Sofosbuvir - velpatasvir - voxilaprevir 12 wk, sofosbuvir - velpatasvir - voxilaprevir with or without ribavirin 12-24 wk in G3 cirrhotic patients | RAS screening In addition, for patients with poorer prediction of response sofosbuvir - glecaprevir - pibrentasvir and sofosbuvir - velpatasvir - voxilaprevir 12-24 wk with or without ribavirin according to multidisciplinary decision |
Decompensated cirrhosis | Regimen without protease inhibitors | Regimen without protease inhibitors |
Renal insufficiency | Glecaprevir - pibrentasvir or, grazoprevir - elbasvir (G1) 12 wk | Glecaprevir - pibrentasvir or grazoprevir - elbasvir (G1), 8-12 wk |
APRI: Aspartate aminotransférase to Platelet Ratio Index; DAA: Direct acting antiviral; EASL: European Association for the Study of the Liver; HCV: Hepatitis C virus; RAS: Resistance-associated substitutions.