Effectiveness and safety of sofosbuvir/velpatasvir ± ribavirin vs glecaprevir/pibrentasvir in genotype 3 hepatitis C virus infected patients

Retreatment of patients with chronic hepatitis C, subtype 3a, and cirrhosis, who previously failed a regimen containing second-generation NS5A inhibitors with sofosbuvir + glecaprevir/pibrentasvir and ribavirin for 16-24 weeks

The outcomes of retreatment patients infected with hepatitis C virus genotype 3, cirrhosis, with velpatasvir may be affected by treatment failure with velpatasvir. The efficacy of SOF+GLE/PIB+RIB 16-24 weeks of treatment has been shown. The presence of NS5A resistance-associated substitution mutations, including Y93H, and the number and regimens of the past failed therapy do not influence the likelihood of achieving sustained virological response. When velpatasvir treatment fails, pibrentasvir should be used as the first choice for retreatment.

HCV RNA positivity among hepatitis C patients in Chongqing, China from 2004 to 2021: a cross-sectional study

BACKGROUND

A substantial number of hepatitis C virus (HCV) infections have been diagnosed and reported, yet not all reported patients have received treatment, leading to uncertainties in the progression of the virus within these cases. This study aimed to assess the rate of HCV RNA positivity in the reported cases in Chongqing, China and identify key groups.

METHODS

An investigation was conducted on 6,333 hepatitis C cases who were reported in the China Information System for Disease Control and Prevention in 17 districts of Chongqing, China from 2004 to 2021. The process involved collecting venous blood for HCV RNA and genotype testing, as well as gathering case information through a questionnaire. The analysis focused on comparing the HCV RNA positive rates among patients with different characteristics to identify key groups.

RESULTS

The HCV RNA positive rate was 37.7% among 6,333 cases. Patients who had never received treatment (47.6%) and those treated with interferon (25.6%) showed higher positive rates than those treated with DAAs (8.1%). HCV RNA positive rates were generally higher in the following groups: males, aged 40-49 years and 50-59 years, farmers or manual laborers and the unemployed or job-seeking. Patients with higher income exhibited lower HCV RNA positive rate.

CONCLUSIONS

A considerable portion of reported hepatitis C cases in Chongqing remained HCV RNA positive. Multiple factors contributed to HCV RNA positivity among these patients, necessitating comprehensive interventions to promote adherence to treatment.

Effectiveness and Safety of Pangenotypic Regimens in the Most Difficult to Treat Population of Genotype 3 HCV Infected Cirrhotics

There is still limited data available from real-world experience studies on the pangenotypic regimens in patients with genotype (GT) 3 hepatitis C virus (HCV) infection and liver cirrhosis. The current study aimed to evaluate the efficacy and safety of pangenotypic regimens in this difficult-to-treat population. A total of 236 patients with mean age 52.3 ± 11.3 years and male predominance (72%) selected from EpiTer-2 database were included in the analysis; 72% of them were treatment-naïve. The majority of patients (55%) received the combination of sofosbuvir/velpatasvir (SOF/VEL), 71 without and 58 with ribavirin (RBV), whereas the remaining 107 individuals were assigned to glecaprevir/pibrentasvir (GLE/PIB). The effectiveness of the treatment following GLE/PIB and SOF/VEL regimens (96% and 93%) was higher compared to SOF/VEL + RBV option (79%). The univariate analysis demonstrated the significantly lower sustained virologic response in males, in patients with baseline HCV RNA ≥ 1,000,000 IU/mL, and among those who failed previous DAA-based therapy. The multivariate logistic regression analysis recognized only the male gender and presence of ascites at baseline as the independent factors of non-response to treatment. It should be emphasized that despite the availability of pangenotypic, strong therapeutic options, GT3 infected patients with cirrhosis still remain difficult-to-treat, especially those with hepatic impairment and DAA-experienced.