EASL recommendations on treatment of hepatitis C: Final update of the series☆

Abstract

Hepatitis C virus (HCV) infection is a major cause of chronic liver disease, with approximately 71 million chronically infected individuals worldwide. Clinical care for patients with HCV-related liver disease has advanced considerably thanks to an enhanced understanding of the pathophysiology of the disease, as well as developments in diagnostic procedures and improvements in therapy and prevention. These therapies make it possible to eliminate hepatitis C as a major public health threat, as per the World Health Organization target, although the timeline and feasibility vary from region to region. These European Association for the Study of the Liver recommendations on treatment of hepatitis C describe the optimal management of patients with recently acquired and chronic HCV infections in 2020 and onwards.

Real-World Efficacy and Safety of Pangenotypic Direct-Acting Antivirals Against Hepatitis C Virus Infection in Taiwan

“…The choice of a suitable DAA regimen is complex initially, and the HCV genotype is one of the major factors determining an appropriate genotype-speci c DAA. With the advent of pangenotypic DAA regimens, hepatitis C treatment has been simpli ed, and HCV genotyping is no longer an absolute requirement before initiating treatment [9].…”

Therapy Implications of Hepatitis C Virus Genetic Diversity

“…However, the complex HCV quasispecies dynamics expected from low-fidelity replication can allow the selection of DAA RASs that may significantly impact treatment outcomes [72,97]. In very difficult-to-cure patients, who failed twice o more to achieve SVR after a combination regimen that included a protease and/or an NS5A inhibitor, the triple potent pan-genotypic combinations of SOF/VEL/voxilaprevir or SOF/glecaprevir/pibrentasvir are showing promising results, even with patients that have DAA RASs at baseline of retreatment [88].…”

“…Individuals who fail to respond to DAA therapies have exhibited RASs at NS3-156, which might reduce the clinical effectiveness of these new combination treatments. In this contest, clinical guidelines recommend HCV resistance testing prior to retreatment in patients who failed after any of the DAA-containing treatment regimens [88]. The resistance profile observed in these resistance tests can guide retreatment.…”

“…In brief, the combination of glecaprevir and pibrentasvir should be avoided in the retreatment of patients who failed a prior DAA-containing regimen, particularly if this regimen contained an NS5A inhibitor. As an alternative, a triple combination of SOF with an NS3 protease inhibitor and an NS5A inhibitor appears to be better suited to retreatment of DAA exposed patients [88]. Since pibrentasvir has an in vitro higher barrier to resistance than all other approved NS5A inhibitors [94], a triple combination with this DAA may be an interesting alternative for retreatment of difficult-to-cure patients [88].…”

Direct‐acting antiviral treatment failure in genotype 2 hepatitis C chronic infection

“…2,3 The LALREAN (Latin American Liver Research Educational and Awareness Network) created in May 2016 a prospectively feed database evaluating real-life evidence about patients with chronic HCV undergoing treatment with different DAA regimens. In its first report, including 107 HCV G2 patients treated with SOF/DCV ± R, we described an SVR of 100% (95% CI: 96.6-100) 4.…”