Background Hepatitis C virus infection is the leading cause of liver cirrhosis, hepatocellular carcinoma and liver transplantation, and is associated with an increasing mortality rate in infected individuals. The availability of direct acting antiviral agents (DAA) has recently transformed the treatment of chronic hepatitis C (CHC).
Purpose To evaluate the effectiveness of the new DAA in patients with CHC genotype 4 and to analyse the influence of liver fibrosis and previous treatment with pegylated interferon-ribavirin (PEG-IFN/RBV).
Material and methods A descriptive study was conducted in the pharmaceutical care unit. All patients with CHC subtype 4, monoinfected or coinfected with HIV, who received DAA available from January to May 2015 were included. The DAA available at that time were: simeprevir, sofosbuvir, daclatasvir and sofosbuvir/ledipasvir. The variables studied were: gender, liver fibrosis, previous response to PEG-IFN/RBV and viral load. We used the Metavir score system to define liver fibrosis, graded on a 5 point scale from F0 (no fibrosis) to F4 (cirrhosis). Effectiveness was established as sustained virologic response, identified as viral load undetectable, 4 weeks after the end of treatment (SVR4).
Results 29 patients (20 men) were included in our study of whom 20 were coinfected. Simeprevir+sofosbuvir combination was used in 22 patients, sofosbuvir+daclatasvir in 4, PEG-IFB/RBV+simeprevir in 2 and sofosbuvir+ledipasvir in 1. According to the Metavir score, 2 had F1-F2, 5 had F-3 and 22 had F-4 liver fibrosis. According to previous treatment, 16 were naive, 2 were in relapse, 2 were partial and 7 were null responders. Of the total number of patients, 26 had SVR4 and 3 did not have SVR4; 2 patients receiving simeprevir+sofosbuvir and 1 receiving PEG-IFN/RBV+simeprevir; one had F-3 and 2 had F-4 fibrosis, and these 3 patients were naïve.
Conclusion Simeprevir-sofosbuvir was the most common combination used. A higher proportion of patients had SVR4. Treatment failures with the new DAA were correlated with patients with higher grades of fibrosis and naïve treatment. Although these preliminary results need to be verified 12 weeks after the end of treatment, they provide useful effectiveness information.
No conflict of interest.
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