This version of the guidance has been updated to reflect several important developments in the identification and management of chronic hepatitis C. Sections of the guidance where key updates occurred are listed below:

Monitoring

• This section has been updated to include guidance for patients with incomplete adherence.

Patients With HIV/HCV Coinfection:

• This section was updated with drug-drug interaction information for newer antiretroviral agents and ribavirin was removed.

Initial Treatment of Adults with HCV Infection:

• Elbasvir/grazoprevir was changed from recommended regimen to alternative regimen for genotype 1a, due to ribavirin use.
• Elbasvir/grazoprevir remains a recommended regimen for genotype 1b, as it does not require ribavirin.

Renal Impairment:

• Includes updated information based on FDA approval of sofosbuvir for patients with renal disease
• Section notes that acute interstitial nephritis has been associated with DAA use.
• Section on elbasvir/grazopervir was moved towards the end of the section as it is rarely used.

HCV in Children:

• Updated information based on FDA approval for DAA therapy in patients 3 years and older.

Updated references have been provided throughout the guidance where appropriate.