ABSTRACT
BACKGROUND: Patients with inherited blood disorders (IBLD) have a high risk of hepatitis C virus (HCV) infection. The aim of this work was to assess the efficacy and safety of HCV direct-acting antiviral (DAA)-based treatment in patients with IBLD and chronic HCV infection. METHODS: Twenty-seven patients (25 with sickle cell disease, 1 with ß-thalassemia and 1 with hemoglobin D-Punjab), including 3 with compensated cirrhosis, were included. They were treated with sofosbuvir in combination with ribavirin, daclatasvir, ledipasvir, or velpatasvir or with grazoprevir/elbasvir for 8 or 12 weeks. In the case of treatment failure, in-vitro assessment of resistance-associated substitutions (RASs) and full-length genome sequence analysis by means of deep sequencing were performed. RESULTS: Treatment was safe and well-tolerated and there were no drug discontinuations due to DAA-related adverse events. Twenty-five out of the 27 patients (93%) achieved sustained virological response 12 weeks post-treatment. One patient discontinued after 18 days due to adverse events unrelated to the antiviral treatment. One patient infected with 'unusual' genotype 2 subtype 2m relapsed. Subtype 2m naturally carries the NS5A L31M RAS. In a genotype 2a subgenomic replicon model, L31M increased daclatasvir effective concentration 50% (EC50) by 97-fold, but velpatasvir EC50 by only 3-fold, without altering the replication capacity. This patient was successfully retreated with sofosbuvir/velpatasvir for 12 weeks. CONCLUSION: DAA-based regimens are well tolerated and highly efficacious in patients with chronic hepatitis C and IBLD in the real-world setting. Thus, DAA-based antiviral treatment should be prioritized in this thus far neglected population of HCV-infected patients.
Subject(s)
Hepatitis C, Chronic , Hepatitis C , Antiviral Agents/adverse effects , Drug Resistance, Viral/genetics , Drug Therapy, Combination , Genotype , Hepacivirus/genetics , Hepatitis C/epidemiology , Humans , Sofosbuvir/adverse effects , Sustained Virologic Response , Treatment OutcomeABSTRACT
OBJECTIVES: Since little is currently known about predictors of response to direct-acting antiviral agents (DAAs) in people who inject drugs, we undertook an analysis of patients attending a hepatitis clinic with addiction services (outpatient clinics and inpatient services) to examine the outcomes associated with the treatment of difficult-to-manage patients with substance use. Our experience was based on integrated care. METHOD: A retrospective analysis was undertaken of 50 patients with hepatitis C virus (HCV) and a history of addiction who received treatment with DAAs, according to European guidelines. These regimens were sofosbuvir/ledipasvir for 8 weeks (nâ=â3), sofosbuvir/ledipasvirâ±âribavirin for 12 weeks (nâ=â19), sofosbuvir/daclatasvir for 12 weeks (nâ=â20), sofosbuvir/simeprevir (nâ=â1), or sofosbuvir/daclatasvir for 24 weeks (nâ=â7). Characteristics of patients who did versus did not achieve a sustained virologic response (SVR) 12 weeks after treatment were compared by univariate analysis. RESULTS: Forty-two patients (84%) were male; mean age was 46.2â±â7.3 years. Genotypes were 1 (nâ=â21), 2 (nâ=â4), 3 (nâ=â18), 4 (nâ=â6), or 6 (nâ=â1). Most patients were treatment-naïve (nâ=â38). Five patients had coinfection with human immunodeficiency virus (nâ=â4) or hepatitis B (nâ=â1), 28 (56%) had evidence of cirrhosis on FibroScan (>12.5âkPa), and 34 (68%) were receiving opioid substitution therapy. Psychiatric disease, illicit drug use, unemployment, and homelessness/precarious housing were common. Forty-five patients (90%) achieved SVR, 2 were lost to follow-up, and 3 had treatment relapse. CONCLUSIONS: SVR was not significantly associated with sociodemographic or virological characteristics, treatment, social environment, alcohol/drug use, and adherence. Although adherence was slightly worse than in "usual" patients, it did not affect the SVR rate. In these difficult-to-manage patients with HCV and substance use disorder, the real-world SVR rate (90%) was similar to that in nonaddicted populations.
Subject(s)
Antiviral Agents/therapeutic use , Delivery of Health Care, Integrated , Hepatitis C, Chronic/drug therapy , Substance-Related Disorders/complications , Adult , Benzimidazoles/therapeutic use , Carbamates , Drug Therapy, Combination , Female , Fluorenes/therapeutic use , Genotype , Hepacivirus/drug effects , Humans , Imidazoles/therapeutic use , Logistic Models , Male , Middle Aged , Multivariate Analysis , Pyrrolidines , Retrospective Studies , Ribavirin/therapeutic use , Simeprevir/therapeutic use , Sofosbuvir , Sustained Virologic Response , Treatment Outcome , Uridine Monophosphate/analogs & derivatives , Uridine Monophosphate/therapeutic use , Valine/analogs & derivativesABSTRACT
We assessed the broadly used, off-label combination of sofosbuvir, daclatasvir, simeprevir, and ribavirin in direct-acting antiviral-experienced patients, as recommended in current guidelines despite scarce data. After 24 weeks' treatment, sustained virological response 12 weeks after the end of treatment was achieved in 6 patients (60%). Two cirrhotic patients relapsed and 2 discontinued treatment due to serious adverse events.