European Association for the Study of the Liver and French hepatitis C recent guidelines: The paradigm shift

Table 1 French and European Association for the Study of the Liver recommendations principal similitudes and differences

	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.