Treatment of the most difficult-to-cure hepatitis C virus-infected population with sofosbuvir / velpatasvir.

Robert Flisiak, Dorota Zarębska-Michaluk, Hanna Berak, Magdalena Tudrujek-Zdunek, Beata Lorenc, Krystyna Dobrowolska, Justyna Janocha-Litwin, Włodzimierz Mazur, Anna Parfieniuk-Kowerda, Jerzy Jaroszewicz

Pangenotypic therapies for infections with hepatitis C virus (HCV), although universal and highly effective, leave the risk of treatment failure. The analysis aimed to identify the most difficult-to-cure population of HCV-infected patients using the sofosbuvir/velpatasvir (SOF/VEL) regimen. The effectiveness of SOF/VEL with the possible addition of ribavirin  was evaluated in populations known to be less responsive to treatment, and then in a population with a combination of all factors impairing effectiveness in patients treated with this regimen in the EpiTer-2 multicenter retrospective study. A total of 2,267 patients were treated with SOF/VEL±RBV, of whom 2,078 (96.4%) achieved sustained virologic response. The cure rate was 93.5% among 646 patients infected with genotype (GT) 3, 92.3% among 635 patients with cirrhosis, 95.5% in a population of 1,233 men, and reached 94.1% among 421 patients with body mass index (BMI)>30. An analysis in a group of 43 men with cirrhosis and obesity infected with GT3 showed the effectiveness of pangenotypic therapy at only 79.1%, falling to 66.7% in patients with previous treatment failure. Studying a large population of SOF/VEL-treated HCV-infected patients, we showed relatively low effectiveness in treatment-experienced men with cirrhosis and obesity, infected with GT3. Triple therapy should be considered initiating the treatment of HCV infections in this group, which, however, needs to be confirmed in further studies. Previous studies were conducted in a less demanding populations, because they did not take into account gender and body mass index (BMI), which significantly worsen the effectiveness.