Achieving a high cure rate with direct‐acting antivirals for chronic Hepatitis C virus infection in Cameroon: a multi‐clinic demonstration project

Abstract

Objectives Highly effective direct‐acting antivirals (DAAs) for Hepatitis C treatment are largely inaccessible in sub‐Saharan Africa. Data on treatment feasibility and outcomes in clinical settings are limited. We assessed the feasibility of achieving a high (≥90%) cure rate with DAAs in six gastroenterology clinics in Cameroon. Methods Patients with chronic Hepatitis C virus (HCV) infection were treated for 12 or 24 weeks with ledipasvir/sofosbuvir, ledipasvir/sofosbuvir/ribavirin or sofosbuvir/ribavirin, depending on the stage of liver disease and HCV genotype. The cure rate was defined as the proportion of patients with a sustained virological response 12 weeks after treatment completion (SVR12) among all treatment completers. Results We identified 190 HCV RNA positive patients between September‐2017 and August‐2018, 161 (84.7%) of whom started treatment. 105 (65.2%) were female, median age was 61.3 years [IQR = 55.9–66.9] and 11 (6.8%) were HIV‐positive. Median plasma HCV RNA was 6.0 log10 IU/mL [IQR = 5.6–6.4]. HCV genotypes identified were 1 (34.8%), 2 (13.7%), 4 (50.9%), 1 and 4 (0.6%); 46 (28.6%) strains of 160 single‐genotype infections were non‐subtypeable. Of 158 treatment completers, 152 (96.2%, 95%CI = 91.9–98.6%) achieved SVR12. Six patients did not achieve SVR12: five carried HCV with NS5A resistance mutations and one with NS5B resistance mutations. Three patients died before and two after treatment completion. The most common adverse events were asthenia (12.0%), headache (11.4%) and dizziness (18.9%). Conclusion High cure rates of Hepatitis C with DAAs are achievable in clinical settings of Cameroon. However, the accessibility and provision of HCV screening, diagnosis, treatment, monitoring and care should be addressed for large‐scale implementation.

Treatment of viral hepatitis C genotypes 1 and 2 by sofosbuvir and ledipasvir with or without ribavirin combination: A possible alternative to pangenotypic treatment in a low-income country?

“…Wilder et al (2016) reported a similar SVR in black and non-black patients (95% vs 97%) with genotype 1 HCV infection. For HCV genotype 2, treatment with Sofosbuvir/Ledipasvir for 12 weeks was associated with elevated SVR rates in the study of Gane et al (2017) Hamadou et al, 2018;Coyer et al, 2020;Lawson-Ananissoh et al, 2019;Abozeid et al, 2018). A single-center study (Mairamou Hamadou et al, 2018) in Cameroon, 45/53 patients (84.9%) with HCV genotype 1 under Sofosbuvir/Ledipasvir  Ribavirin obtained an SVR, lower compared to our results.…”

“…A single-center study (Mairamou Hamadou et al, 2018) in Cameroon, 45/53 patients (84.9%) with HCV genotype 1 under Sofosbuvir/Ledipasvir  Ribavirin obtained an SVR, lower compared to our results. But a multicenter study in Cameroon (Coyer et al, 2020) J o u r n a l P r e -p r o o f Abozeid et al (2018), in Egypt had reported no difference in terms of efficacy between the Sofosbuvir/Ledipasvir  Ribavirin regimen (generics: 100% vs branded molecules: 98.2%; p=0.729) and Sofosbuvir/Daclatasvir  Ribavirin (generics: 97.8% vs. branded molecules: 98.1%; p=0.729).…”

“…Pangenotypic direct-acting antivirals are not easily accessible to populations in low-income countries (Spearman et al, 2019). The combinations Sofosbuvir/Ledipasvir  Ribavirin and Sofosbuvir/Ribavirin remain the most used in African patients infected with HCV genotypes 1 and 2 (Mairamou Hamadou et al, 2018;Coyer et al, 2020;Lawson-Ananissoh et al, 2019;Abozeid et al, J o u r n a l P r e -p r o o f 2018). The Sofosbuvir/Ribavirin combination, initially recommended in HCV genotype 2, is used less and less because of its low sustained virological response rate (SVR) in cirrhotic patients (Scott et al, 2018;AASLD-IDSA, 2020;EASL, 2018).…”

Challenge of managing hepatitis B virus and hepatitis C virus infections in resource-limited settings

“…The prices of WHO-recommended DAAs for HCV vary substantially (US$200–45 000 for a curative course), but prices have been dropping, and most LMICs should be able to buy generic medicines at affordable prices[ 2 , 43 ]. Currently, HCV can be treated within 8–12 wk with highly effective DAAs and high cure rates[ 44 , 45 ]. Introducing locally produced pharmaceutical products paves the way for further lowering prices.…”

A small-scale Development Impact Bond for hepatitis C diagnosis and treatment in Cameroon: the way to elimination?

“…Another barrier for early treatment is the lack of screening programs to detect asymptomatic HCV patients. Having showed high cure rates for HCV carriers with DAAs in clinical settings in Cameroon (Coyer et al, 2020), accessibility and provision of the HCV care continuum should subsequently be addressed to ensure effective large-scale implementation and potential elimination.…”