EASL recommendations on treatment of hepatitis C - Final update - Clinical care guidance

Sep 25, 2026

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Hepatitis C virus (HCV) infection is a major driver of chronic liver disease worldwide, affecting approximately 71 million people chronically. Clinical care has advanced through better understanding of disease pathophysiology, improved diagnostics, and more effective therapy and prevention. These EASL recommendations outline optimal management for acute and chronic HCV infection in 2020 and beyond, aiming for cure via sustained virological response (SVR). SVR reduces liver-related events and mortality, though benefits vary by regional access and patient factors.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages49

Reading Time2 h 3 min

AccessFree to download

Summary

Introduction

Background

Primary goal of HCV therapy

Methodology

Evidence grading (GRADE system)

Practice Guidelines EASL recommendations on treatment of hepatitis C: Final update of the seriesq European Association for the Study of the Liver* Summary Hepatitis C virus (HCV) infection is a major cause of chronic liver disease, with approximately 71 million chronically infected individuals worldwide. Clinical care for patients with HCV-related liver disease has advanced considerably thanks to an enhanced understanding of the pathophysiology of the disease, as well as developments in diagnostic procedures and improvements in therapy and prevention. These therapies make it possible to eliminate hepatitis C as a major public health threat, as per the World Health Organization target, although the timeline and feasibility vary from region to region. These European Association for the Study of the Liver recommendations on treatment of hepatitis C describe the optimal management of patients with recently acquired and chronic HCV infections in 2020 and onwards. © 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved. Introduction Background In 2015 it was estimated that there were approximately 71 million individuals chronically infected with hepatitis C virus (HCV) worldwide,1,2 many of whom were unaware of their infection.3 HCV infection remains one of the main causes of chronic liver disease worldwide.1,4 The long-term natural history of HCV infection is highly variable: the hepatic injury can range from minimal necro-inﬂammatory changes to extensive ﬁbrosis and cirrhosis with or without hepatocellular carcinoma (HCC). Clinical care for patients with HCV-related liver disease has advanced considerably during the last couple of decades, thanks to an enhanced understanding of the pathophysiology of the disease, and because of developments in diagnostic procedures and radical improvements in therapy and prevention. The primary goal of HCV therapy is to cure the infection, i.e. to achieve a sustained virological response (SVR) deﬁned as undetectable HCV RNA after treatment completion. An SVR corresponds to a cure of the HCV infection, as late relapse Received 18 August 2020; accepted 18 August 2020; available online 15 September 2020 qClinical Practice Guidelines Panel: Chair: Jean-Michel Pawlotsky; EASL Governing Board representative: Francesco Negro; Panel members: Alessio Aghemo, Marina Berenguer, Olav Dalgard, Geoffrey Dusheiko, Fiona Marra, Massimo Puoti, Heiner Wedemeyer. * Corresponding author: Address: European Association for the Study of the Liver (EASL), The EASL Building – Home of Hepatology, 7 rue Daubin, CH 1203 Geneva, Switzerland. Tel.: +41 (0) 22 807 03 60; Fax: +41 (0) 22 328 07 24. E-mail address: easlofﬁce@easlofﬁ[ce.eu](ce.eu). [https://doi.org/10.1016/j.jhep.2020.08.018](https://doi.org/10.1016/j.jhep.2020.08.018) occurs in less than 0 .2% of cases beyond 6 months of followup.5 An SVR is generally associated with normalisation of liver enzymes and improvement or regression of liver necroinﬂammation and ﬁbrosis, and improvement in liver function.6–8 The risk of HCC and liver-related mortality is signiﬁcantly reduced, but not eliminated, in patients with cirrhosis who clear HCV compared to untreated patients and non-sustained virological responders, especially in the presence of cofactors of liver morbidity, such as the metabolic syndrome, harmful alcohol consumption and/or concurrent hepatitis B virus (HBV) infection.6,9–17 HCV is also associated with a number of extrahepatic manifestations, but viral elimination can reduce allcause mortality.18–25 This ﬁnal update of the EASL Recommendations on Treatment of Hepatitis C series started in 2014 is intended to assist physicians and other healthcare providers, as well as patients and other interested individuals, in the clinical decisionmaking process, by describing the current optimal management of patients with acute and chronic HCV infections. These recommendations apply to therapies

FAQs

What is the primary goal of HCV therapy in these EASL recommendations?

The primary goal is to cure the infection by achieving a sustained virological response (SVR), defined as undetectable HCV RNA after treatment completion.

How do EASL recommendations define SVR and what does it indicate clinically?

SVR corresponds to cure of HCV infection and is generally linked to normalization of liver enzymes as well as improvement or regression of liver inflammation and fibrosis.

On what basis were the EASL recommendations developed, and how is evidence quality graded?

Recommendations were prepared by an expert panel using evidence from existing publications and international presentations, and in some areas expert experience. Evidence and recommendations are graded using the GRADE system, classifying evidence quality as high (A), moderate (B), or low (C), with strong (1) or weak (2) strength.

Sep 25, 2026

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