OBJECTIVES: To describe patterns and factors influencing real-world management of Danish patients infected with Hepatitis C virus (HCV). METHODS: From DANHEP, a national Danish HCV/HBV registry, we identified HCV genotype 1 or 4 patients initiating the following treatment strategies between 2011 and 2014 (excluding early access programs): 2^nd and 1^st generation direct-acting antivirals (2GDAA and 1GDAA), dual therapy (DT), or no treatment (NT). Patients could have ≥1 treatment episode. We estimated proportion treated, treatment duration, and describe patients according to HCV strategy initiated. RESULTS: Among 1,988 patients with 7,209 treatment episodes (including NT), proportion of patients treated yearly was low (range: 0.9-4.2%) and lowest in 2013, just prior to 2GDAA market entry. In 2014, 96.4% (53/55) of treatment episodes (excluding NT) were with 2GDAAs. Most 2GDAA treatments initiated were interferon-free (N=44/53; 83.0%), with uptake highest for simeprevir-sofosbuvir (31/53; 58.5%) and sofosbuvir-daclatasvir (11/53; 20.8%) combination therapy. Average completed treatment duration (in weeks) with 2GDAAs (13.8, SD=5.4; N=33) was shorter than for 1GDAAs (32.0, SD=17.7; N=102) and DT (32.2, SD=17.9; N=42), in accordance with approved treatment duration. Interferon-free 2GDAA treatment with ribavirin (16.6, SD=4.7; N=12) was longer than without ribavirin (12.0, SD=4.4; N=13); ribavirin may selectively be used for harder to treat patients as suggested by higher cirrhosis prevalence (76.9% vs. 56.5%) and previous treatment exposure (64.7% vs. 44.4%). Patients initiating 2GDAAs were more commonly cirrhotic (55.6% vs. 30.8% for 1GDAA, 35.3% for DT, 15.5% for NT) and previously treated (50.9% vs. 35.3% for 1GDAA, 26.2% for DT, 3.7% for NT) than initiators of other strategies, in line with Danish reimbursement criteria for 2GDAAs. CONCLUSIONS: Proportion of patients treated remains low (<5%), despite availability of novel 2GDAAs.  Treatment patterns are sensitive to market entry of new HCV medications. HCV treatment selection and duration may be influenced by disease severity and treatment history.