The advent of highly effective direct acting antiviral (DAA) therapy in the management of these difficult-to-treat chronic hepatitis C subpopulation has significantly improved sustained virologic response (SVR, absence of HCV RNA in plasma 12 weeks after cessation of therapy), while maintaining an excellent safety profile (3-5). Achieving SVR has resulted in reversal of the degree of fibrosis, reduction in the risk of hepatocellular carcinoma, lowers the rate of hepatic decompensation, and perhaps curtails the need for liver transplantation (2,6,7). However, lack of availability of a pan-genotypic regimen has limited our ability to expand HCV treatment beyond patients infected with genotype 1 thus far. In particular, there are limited options to treat patients with HCV genotype 3, especially with decompensated liver disease (8). Recently, Dr. Michael P. Curry and the ASTRAL-4 investigators conducted a study using a once daily fixed dose combination regimen containing a widely used nucleotide analogue NS5B polymerase inhibitor, sofosbuvir, and a more recently FDA-approved novel NS5A inhibitor, velpatasvir, with or without the use of ribavirin to treat chronic hepatitis C adult patients with decompensated cirrhosis (9).