Background Hepatitis C is a serious disease with high prevalence, being the leading cause of liver transplantation. The development of well-tolerated and highly-effective direct acting antivirals (DAAs) for hepatitis C virus (HCV) has dramatically changed the therapeutic landscape

Purpose Assessing of the effectiveness of sofosbuvir/ledipasvir (SOF/LDV), paritaprevir/ombitasvir/ritonavir±ribavirin (PTV/OBV/r±RBV) and sofosbuvir/simeprevir (SOF+SIM) used for the treatment of the hepatitis C virus genotype-4 infection.

Material and methods Retrospective and observational study during year 2015. Inclusion criteria: patients with HCV genotype-4 infection treated for 12 weeks either with SOF/LDV or SOF+SIM or PTV/OBV/r±RBV during study period. Exclusion criteria: patients with no data available. Outcomes collected: demographics: age and sex. Clinical data: basal viral load (VL), SVR at week 12 (SVR12), defined as HCV RNA titres lower than 15 IU/mL. METAVIR score: F0 to F4. Liver transplant; HIV co-infection; previous treatments for HCV. Data were collected from the medical records of patients.

Results Treatment SOF/LDV: 21 patients were included (75% males) with mean age of 52±6.60 years. METAVIR score: F4 (cirrhosis) (33.33%); F3 (33.33%); F2 (19.04%) and F1 (14.28%). 66.66% patients were HIV-coinfected and no patients was liver transplanted. Fifty per cent were pretreated with ribavirin/peginterferon and 28.57% had a basal VL >800,000 UI/ml. All patients (21/21=100%) achieved SVR12.

Treatment SOF+SIM: 23 patients (86.95% males) were included with mean age 51.88±4.33 years. METAVIR score: F4 (cirrhosis) (47.82%); F3 (39.14%); F2 (13.04%). HIV-coinfected patients 43.47%, pretreated with ribavirin/peginterferon 52.17% and 52.17% had basal VL>800,000 UI/ml. 86.95% (20/23) achieved SVR12, one naive-non-cirrhotic patient and two pre-treated-cirrhotic patients did not get SVR12.

Treatment PTV/OBV/r±RBV: 26 patients (88.46% males) were included with mean age 51.60±4.34 years. METAVIR score: F4 (cirrhosis) (46.15%); F3 (38.46%); F2 (15.38%). HIV-coinfected patients 38.46%, pre-treated with ribavirin/peginterferon 19.23% and 50% had basal VL>800,000 UI/ml. 96.15% (25/26) achieved SVR12.

Conclusion The SVR12 rates achieved in this study with the treatments SOF/LDV and PTV/OBV/r±RBV match the results obtained in published clinical trials ION-4 and PEARL-I, respectively. In the SOF+SIM group, 86.95% achieved SVR12, which is slightly lower than the value obtained in the PLUTO study. Indeed, these new drugs show a high rate of response, which has revolutionised the management of chronic hepatitis C.

No conflict of interest