AASLD-IDSA 2019/2020 Hepatitis C Guidance: testing and treatment update

Official guidelineHepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases-Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection. AASLD, 2020.
Read the official guideline · Checked for a newer edition on 2026-10-20
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Who it applies to

Adults and adolescents with confirmed or suspected hepatitis C virus infection evaluated in primary care or specialty settings, including people who inject drugs, those with cirrhosis, HIV coinfection, renal impairment, and prior treatment failures.

Key recommendations

One-time HCV screening (antibody testing) is recommended for all adults aged 18 and older at least once, and for all pregnant women during each pregnancy, regardless of perceived risk.
Periodic repeat testing is recommended for persons with ongoing risk factors, such as people who inject drugs or men who have sex with men with high-risk behavior.
A reactive antibody test should be followed by HCV RNA testing to confirm active (viremic) infection before treatment decisions are made.
Pretreatment HCV genotype testing is not required before starting most pangenotypic DAA regimens, simplifying the treatment pathway.
Treatment with DAAs is recommended for essentially all patients with chronic HCV infection, except those with short life expectancy that cannot be improved by treatment, liver transplantation, or antiviral therapy.
Simplified treatment algorithms using fixed-dose combination pangenotypic regimens (such as sofosbuvir-velpatasvir or glecaprevir-pibrentasvir) for 8 to 12 weeks are endorsed for treatment-naive patients without cirrhosis or with compensated cirrhosis in appropriate settings.
People who inject drugs should be offered the same DAA treatment as other populations, since ongoing drug use is not a contraindication to therapy.
Patients with decompensated cirrhosis should avoid protease inhibitor-containing regimens and be managed in conjunction with or referred to a liver specialist.
Sustained virologic response at 12 weeks after completing treatment (SVR12) confirms cure and should be assessed with HCV RNA testing.
Patients with cirrhosis who achieve cure still require ongoing surveillance for hepatocellular carcinoma, as this risk persists after SVR.

What is new in this edition

Updated guidance incorporated simplified, genotype-independent treatment algorithms for treatment-naive patients to make prescribing feasible for non-specialist providers.
Expanded and reinforced recommendations supporting treatment of people who inject drugs without requiring abstinence.

Practice points for students

Universal one-time screening for all adults is now standard, not just risk-based testing.
Confirm active infection with HCV RNA before assuming a positive antibody result means current infection.
Genotype testing is largely unnecessary before starting modern pangenotypic DAA therapy.
Active drug use alone is not a reason to withhold or delay DAA treatment.
SVR12 is the test of cure, but cirrhotic patients still need lifelong HCC surveillance even after cure.

Condition

Hepatitis C