ABSTRACT
This study aimed to investigate the efficacy and safety of sofosbuvir-based therapies for the treatment of cirrhosis from hepatitis C virus (HCV) genotype 2 infection. Data of all consecutive HCV genotype 2 cirrhotic patients who started sofosbuvir-based treatments between January 2015 and March 2017 in eight Italian tertiary hospitals were collected retrospectively. Overall, 273 patients (Child A: 94.5%) were enrolled. In the 194 subjects treated with sofosbuvir/ribavirin, median initial ribavirin dosage was 13.9 mg/kg/day, and therapy duration was 16 weeks. Sustained virological response (SVR) rates were 93.8% in intention-to-treat (ITT) and 95.3% in per-protocol (PP) analyses for the 129 treatment-naïve patients, and 96.9% (ITT) and 98.4% (PP) for the 65 treatment-experienced subjects. Adverse events were reported in 142 patients (73.2%), but only 1.5% discontinued treatment. Eighty-eight subjects with treatment-induced anemia (mild: 34.5%, moderate: 7.7%, severe: 3.1%) had to reduce ribavirin dosage, but SVR rates were comparable to the weight-based dose group, both in ITT (95.4% and 94.3%) and PP (97.7% and 95.2%) analyses, respectively. Moreover, ITT and PP SVR rates were similar between shorter (<20 weeks) (94.1% and 96.0%, respectively) and prolonged (≥20 weeks) regimens (95.7% and 96.7%, respectively). SVR rates in the 79 subjects treated with sofosbuvir/daclatasvir (without ribavirin) were similar (ITT: 96.2%; PP: 97.4%, respectively), without de novo/worsening anemia. In conclusion, in a real-life study centered on genotype 2 patients with well-compensated cirrhosis, sofosbuvir-based regimens were associated with good SVR and tolerability rates, regardless of previous antiviral treatments, without a significant impact of on treatment ribavirin dose reductions.
Subject(s)
Antiviral Agents/administration & dosage , Carbamates/administration & dosage , Hepacivirus/genetics , Hepatitis C, Chronic/drug therapy , Imidazoles/administration & dosage , Liver Cirrhosis/drug therapy , Pyrrolidines/administration & dosage , Ribavirin/administration & dosage , Sofosbuvir/administration & dosage , Valine/analogs & derivatives , Adult , Aged , Aged, 80 and over , Antiviral Agents/adverse effects , Carbamates/adverse effects , Drug Therapy, Combination , Female , Genotype , Hepatitis C, Chronic/complications , Hepatitis C, Chronic/virology , Humans , Imidazoles/adverse effects , Liver Cirrhosis/etiology , Liver Cirrhosis/virology , Male , Middle Aged , Pyrrolidines/adverse effects , RNA, Viral/genetics , Retrospective Studies , Ribavirin/adverse effects , Sofosbuvir/adverse effects , Treatment Outcome , Valine/administration & dosage , Valine/adverse effectsABSTRACT
Alkhurma hemorrhagic fever virus (AHFV) is a tick-borne flavivirus with high case fatality rates, endemic in the Arabian Peninsula. Recently AHFV was detected in travelers returning from Egypt suggesting geographical spreading. We also report AHFV infection in a traveler ex Egypt, representing atypical symptoms of rhabdomyolysis and severe muscular weakness.