Are There Still Difficult-to-Treat Patients with Chronic Hepatitis C in the Era of Direct-Acting Antivirals?

Abstract

Difficult-to-treat populations with chronic hepatitis C (CHC), in the era of interferon treatment, included patients with liver cirrhosis, kidney impairment, treatment-experienced individuals, and those coinfected with the human immunodeficiency virus. The current study aimed to determine whether, in the era of direct-acting antivirals (DAA), there are still patients that are difficult-to-treat. The study included all consecutive patients chronically infected with hepatitis C virus (HCV) who started interferon-free therapy between July 2015 and December 2020 in the Department of Infectious Diseases in Kielce. The analyzed real-world population consisted of 963 patients, and most of them were infected with genotype 1 (87.6%) with the predominance of subtype 1b and were treatment-naïve (78.8%). Liver cirrhosis was determined in 207 individuals (21.5%), of whom 82.6% were compensated. The overall sustained virologic response, after exclusion of non-virologic failures, was achieved in 98.4%. The univariable analysis demonstrated the significantly lower response rates in males, patients with liver cirrhosis, decompensation of hepatic function at baseline, documented esophageal varices, concomitant diabetes, body mass index ≥25, and previous ineffective antiviral treatment. Despite an overall very high effectiveness, some unfavorable factors, including male gender, genotype 3 infection, liver cirrhosis, and treatment experience, significantly reduce the chances for a virologic response were identified.

Effectiveness and Safety of Sofosbuvir/Velpatasvir/Voxilaprevir as a Hepatitis C Virus Infection Salvage Therapy in the Real World: A Systematic Review and Meta-analysis

“…The study of Pabjan et al [45] also demonstrated that in addition to GT3-infected and cirrhotic patients, male sex and treatment experience significantly reduced the chances of virologic response. However, in our study, there was no significant difference in the SVR12 rate between males and females in both the ITT and PP populations.…”

Incidence and Risk Factors of Reinfection with HCV after Treatment in People Living with HIV

“…Liver cirrhosis was also a risk factor of reinfection in our study, with an incidence of 18.1/100PY noted (AHR, 3.94; 95% CI 1.09-14.22), though we could not distinguish reinfection from relapse due to a lack of phylogenetic analysis of HCV strains. Nonetheless, Pawel et al demonstrated significantly lower response rates in patients with liver cirrhosis in their research (odds ratio, 4.43; 95% CI, 1.59-12.38) [24].…”

Effectiveness of pangenotypic retreatment of chronic hepatitis C after prior failure of pangenotypic therapies

“…The very high overall success rate of DAA therapy, exceeding 95%, has made the problem of nonresponse to treatment in chronic hepatitis C marginal. However, experience in recent years shows that there are still patients with a lower chance of therapeutic success [19][20][21]. Effective retreatment options for patients who have not responded to DAA therapy are a key prerequisite for achieving the WHO's goal of HCV elimination.…”