Sofosbuvir and ribavirin for 6 weeks is not effective among people with recent hepatitis C virus infection: The DARE‐C II study

Abstract

Six weeks of sofosbuvir and ribavirin was safe and well tolerated, but efficacy was suboptimal; further research is needed to determine whether more potent interferon-free direct-acting antiviral regimens will allow treatment duration to be shortened in recent, predominantly asymptomatic HCV infection. (Hepatology 2016;64:1911-1921).

A Robust and Efficient Numerical Method for RNA-Mediated Viral Dynamics

“…While individuals with recent HCV infection might not be at steady state at initiation of DAA therapy [3], it may be feasible to assume a quasi-steady state with lower pre-treatment HCV RNA levels, as observed in some subjects, which could be adjusted by changing model parameters.…”

“…Approximately 400,000 people die each year from HCV, mostly from cirrhosis and hepatocellular carcinoma [2]. There is no vaccine for HCV and for more than a decade the standard-of-care of pegylated interferon-alpha (IFN) and ribavirin was suboptima [3]. However the recent advent of direct-acting antivirals (DAAs) allows for interferon-free, all-oral treatment yielding cure rates exceeding 90% with pangenotypic activity and shorter durations of therapy (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) weeks) compared to IFN-based therapy (24-48 weeks [4]).…”

“…However the recent advent of direct-acting antivirals (DAAs) allows for interferon-free, all-oral treatment yielding cure rates exceeding 90% with pangenotypic activity and shorter durations of therapy (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) weeks) compared to IFN-based therapy (24-48 weeks [4]). While these highly effective DAAs are considered one of the greatest achievements in medicine, significant challenges remain for eliminating HCV infection such as finding an optimal approach to current DAA failures, preventing re-infection, identifying all those infected and the high cost of the new DAAs which represents a major barrier to treating the populations that are most affected by HCV [3]. Thus, there exists a continuing need for more affordable therapies, as well as an effective vaccine [5].…”

Current Treatment Approach in Acute Hepatitis C Infection

“…No response to treatment (2), posttreatment relapse (9), reinfection (1), and loss to follow-up (1) were the reasons for treatment failure. The authors emphasized that 6 weeks of sofosbuvir/ribavirin combination have a suboptimal efficacy for acute HCV treatment (4). The EASL has listed the recommended treatment options in the current guidelines for use in acute HCV infection as shown in Table 2 (25).…”

“…Successful treatment of acute HCV infection in high-risk populations, especially in men who have sex with men and intravenous (IV) drug users is very important for the prevention of transmission in population (4,5,6). In the natural course of acute HCV infection, most patients are asymptomatic.…”