Patient handout

Hepatitis C — initial evaluation & DAA

PRODUCTION

1. Your condition

This handout is for hepatitis c — initial evaluation & daa. Your care team identified this based on: hcv antibody positive (idsa 2024).

Other reasons your team may use this plan: hcv rna detectable on screening (idsa 2024); unexplained alt elevation in at-risk individual (idsa 2024); known hcv not yet treated (idsa 2024).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
glecaprevir-pibrentasvir	300/120 mg PO daily (3 tablets of 100/40)	PO with food	daily × 8 weeks	AASLD/IDSA + EASL 2025 — Mavyret 8-week pan-genotypic; non-inferior to 12 weeks (EXPEDITION-8); avoid in decompensated cirrhosis (protease inhibitor)
sofosbuvir-velpatasvir	400/100 mg PO daily	PO	daily × 12 weeks	AASLD/IDSA + EASL 2025 — Epclusa 12-week pan-genotypic; safe in all eGFR (post-EXPEDITION-4/5); preferred in decompensated cirrhosis with ribavirin
sofosbuvir-velpatasvir-voxilaprevir	400/100/100 mg PO daily	PO	daily × 12 weeks	AASLD/IDSA + EASL 2025 — Vosevi salvage for treatment-experienced; not first-line
ledipasvir-sofosbuvir	90/400 mg PO daily	PO	daily × 8-12 weeks	AASLD/IDSA — older but still effective for non-3 genotypes

Plan: HCV pan-genotypic DAA — treatment-naive, compensated (AASLD/IDSA + EASL 2025)

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — On treatment / SVR12 achieved — staying on track (IDSA 2024)

If you have:

Taking DAA every day at the same time, with food if Mavyret
No new symptoms; LFTs stable
Vaccinations up to date (HAV, HBV)

Do this:

Take medication every day; do not skip doses
Bring all OTC and prescription medication lists to every visit (DDIs are common)
Avoid alcohol; reduce reinfection risk (no needle sharing, safer sex if MSM)
Get hepatitis A and B vaccines if not immune
Keep liver imaging appointments q6 months if you have cirrhosis (lifelong, even after cure)

YELLOW — Side effects or new symptoms — call your provider (IDSA 2024)

If you have:

Nausea, headache, fatigue, mild rash
Missed doses
Started a new medication or supplement
New jaundice, dark urine, or right upper-quadrant discomfort

Do this:

Continue medication unless told to stop
Call your provider for guidance — drug interaction or side effect can usually be managed
Do not start new herbal supplements (St Johns Wort) without checking

Call your provider if:

Any new jaundice or dark urine
Missed >2 doses
New medication or supplement

RED — Stop and seek care immediately (IDSA 2024)

If you have:

Severe abdominal pain, confusion, encephalopathy, vomiting blood, black stool (decompensation)
Rapid jaundice progression
Severe rash with fever (DRESS-like)
Pregnancy occurring on regimen including ribavirin

Do this:

Go to the emergency department now
Bring a list of all current medications including DAA

Call your provider if:

Always go to ED for these symptoms — urgent hepatology evaluation required

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

HBsAg+ OR anti-HBc+ alone patient about to start DAA, OR HBV-DNA rise + ALT rise during DAA — life-threatening reactivation risk (FDA boxed warning 2016; AASLD/IDSA 2024)(life-threatening)
Ascites / variceal bleed / hepatic encephalopathy / SBP / Child-Pugh B or C emergence during evaluation or DAA — life-threatening hepatic decompensation (AASLD/IDSA 2024)(life-threatening)
Detectable HCV-RNA at week 4 of DAA, end-of-treatment, or SVR12 (12 weeks post-EOT) — DAA failure with potential NS5A resistance-associated substitutions (AASLD/IDSA 2024; POLARIS-1 / -4)
Cryoglobulinemia / vasculitis / glomerulonephritis / B-cell lymphoma in HCV+ patient (AASLD/IDSA 2024)
HCV+ patient with current pregnancy OR pregnancy occurring during DAA (especially ribavirin-containing regimen) — defer DAA until postpartum; Category X ribavirin teratogenicity (AASLD/IDSA 2024)
Hepatocellular carcinoma detected on surveillance imaging in cirrhotic patient EVEN after SVR12 cure — life-threatening, requires emergent multidisciplinary coordination (AASLD HCC Surveillance Guidance 2023)(life-threatening)
Triple co-infection: HIV+ AND HCV-RNA+ AND HBsAg+ — complex DDI screening + multi-specialty coordination required (AASLD/IDSA 2024; AASLD HBV; DHHS HIV)
Active injection drug use relapse during DAA treatment — adherence intervention + harm reduction; DO NOT discontinue DAA solely for IDU relapse (C-EDGE Co-STAR; SIMPLIFY; AASLD/IDSA 2024 universal-treatment paradigm)
HCV+ patient who is a current organ-transplant recipient (liver, kidney, heart, lung) OR pre-transplant candidate — DAA selection per organ + immunosuppressant-DAA DDI management (AST-IDSA transplant ID; AASLD/IDSA 2024)

5. Follow-up

Cirrhotic → lifelong HCC surveillance US ± AFP q6 months despite cure; reinfection education / harm reduction; hepatology continuity (IDSA 2024)

6. Sources

Guideline: AASLD/IDSA HCV Guidance (continuously updated, 2024-2025 web edition) + EASL 2025 HCV Recommendations