Success of a second treatment of direct-acting antiviral therapy in patients with chronic Hepatitis C Virus infection.

Introduction and Objectives

Direct-acting antivirals (DAAs) are associated with a high sustained viral response (>95%) at 12 weeks (SVR12) in patients with chronic hepatitis C virus (HCV) infection.

There is a low percentage of patients who have treatment failure or reinfection in the presence of persistent risk factors. The indicated treatment is a scheme with voxilaprevir but in Mexico we do not have this option so sofosbuvir-velpatasvir and glecaprevir-pibrentasvir are used. The objective is to report the success of a second-line therapy with DAA in patients with chronic HCV infection.

Materials and Patients

Study: retrospective, descriptive, cross-sectional, single center. Study period: April 2017 to December 2023. Patients over 18 years of age in follow-up at the hepatitis clinic of the Hospital de Especialidades del Centro Médico Nacional Siglo XXI were included, before starting treatment, genotyping and new HCV viral load, laboratory and imaging studies were performed to rule out hepatocellular carcinoma and the cases were discussed by a group of experts at the national level as part of the National Hepatitis C Program of the Mexican Social Security Institute to define the treatment: sofosbuvir- velpatasvir or glecaprevir-pibrentasvir. Descriptive statistics were used to analyze the variables with frequencies and percentages and a table was prepared to show the characteristics of the patients.

Results

900 patients were treated in the study period with reported SVR12 97%; 5 patients with treatment failure were included, total patients received treatment based on sofosbuvir-velpatasvir + ribavirin for 24 weeks, 3 women and 2 men, mean age was 52 years. 3 patients with genotype 1, 1 patient with genotype 3 and only in one patient the genotype was not determined. Forty percent (2) had cirrhosis of the liver. The percentage of adherence to initial treatment was >80% in all patients and none had used a proton pump inhibitor (PPI). The SVR12 percentage was 100%.

(Table 1)

Conclusions

Sofosbuvir-velpatasvir + ribavirin-based treatment is highly effective as a second treatment in patients with a history of first treatment failure, with SVR 12 of 100%.

Ethics statement: Research without risk and approved by the ethics committee.

Declaration of interests: None.

Funding: This research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Table 1.

Characteristics of patients with chronic hepatitis C.

Gender
Female, No. %	3 (60)
Male, No. %	2 (40)
Age, mean, years	52
Genotype
1,No. %	3 (60)
3, No. %	1 (20)
Pre-treatment viral load, mean, UI/ml	297,542
Pretreatment
Sofosbuvir-ledipasvir, No, %	1 (20)
Sofosbuvir-velpatasvir, No, %	3 (60)
Glecaprevir-pibrentasvir, No,%	1 (20)
VIH co-infection, No, %	1 (20)
Percentage of adherence to first treatment	>80%
Liver cirrhosis, No,%	2 (40)