Effectiveness of Treatment of Chronic Viral Hepatitis C by Direct-Acting Antivirals in Togo

Abstract

Background: Viral hepatitis C is the second leading cause of hepatocellular carcinoma after hepatitis B in Africa and Togo in particular. The advent of direct acting antivirals has revolutionized the care and prognosis of patients infected with hepatitis C virus (HCV). Objective: To evaluate the sustained virological response (SVR) 12 weeks after oral treatment without interferon in HCV infected patients with genotypes 1 and 2. Patients and Method: Descriptive and analytical study based on the retrospective collection of data in the hepatogastroenterology unit of the University Hospital Campus of Lome (Togo) from July 11, 2016 to April 22, 2018. All patients who had a chronic viral hepatitis C with viral replication, naive, regardless of the genotype, regardless of the degree of liver fibrosis, and who had completed their treatment with direct-acting antivirals were included. Results: We recruited 84 patients, 60 of whom were infected with HCV genotype 2 (71.43%) and 24 with HCV genotype 1 (28.57%). There were 58 men and 26 women (sex ratio: 0.45). In HCV genotype 1 patients, the median age was 54.29 years and Sofosbuvir/Ledipasvir was the most used combination (62.50%). In HCV genotype 2 patients, the median age was 54.5 years and Sofosbuvir associated with Ribavirin was the most used treatment (81.66%). The virological response at the end of treatment was 100% (genotype 1) and 93.30% (genotype 2). The SVR 12 was 100% (genotype 1) and 91.70% (genotype 2). Five patients were in treatment failure (genotype 2). Conclusion: Direct-acting antivirals were effective in our patients. The rate of sustained virological response was above 90%.

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.…”

“…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).…”