Are There Still Difficult-to-Treat Patients with Chronic Hepatitis C in the Era of Direct-Acting Antivirals?

• Published in: Viruses 2022-01, Vol.14 (1), p.96
• Main Authors: Pabjan, Paweł, Brzdęk, Michał, Chrapek, Magdalena, Dziedzic, Kacper, Dobrowolska, Krystyna, Paluch, Katarzyna, Garbat, Anna, Błoniarczyk, Piotr, Reczko, Katarzyna, Stępień, Piotr, Zarębska-Michaluk, Dorota
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Antiviral agents; Antiviral Agents - therapeutic use; Body mass index; Cirrhosis; Coinfection; Contraindications; Creatinine; Diabetes mellitus; difficult-to-treat; direct-acting antiviral; Drug Therapy, Combination; Esophagus; Failure; Female; Genotype; Genotype & phenotype; Genotypes; Hepacivirus - drug effects; Hepacivirus - genetics; Hepatitis B - complications; Hepatitis C; Hepatitis C, Chronic - complications; Hepatitis C, Chronic - drug therapy; Hepatitis C, Chronic - virology; HIV; HIV Infections - complications; Human immunodeficiency virus; Humans; Immune system; Infections; Infectious diseases; Interferon; Laboratories; Liver; Liver cirrhosis; Liver Cirrhosis - complications; Liver diseases; Male; Middle Aged; Patients; Performance evaluation; Sustained Virologic Response; Treatment Failure; Treatment Outcome; Young Adult
• ISSN: 1999-4915; 1999-4915
• DOI: 10.3390/v14010096

Difficult-to-treat populations with chronic hepatitis C (CHC), in the era of interferon treatment, included patients with liver cirrhosis, kidney impairment, treatment-experienced individuals, and those coinfected with the human immunodeficiency virus. The current study aimed to determine whether, in the era of direct-acting antivirals (DAA), there are still patients that are difficult-to-treat. The study included all consecutive patients chronically infected with hepatitis C virus (HCV) who started interferon-free therapy between July 2015 and December 2020 in the Department of Infectious Diseases in Kielce. The analyzed real-world population consisted of 963 patients, and most of them were infected with genotype 1 (87.6%) with the predominance of subtype 1b and were treatment-naïve (78.8%). Liver cirrhosis was determined in 207 individuals (21.5%), of whom 82.6% were compensated. The overall sustained virologic response, after exclusion of non-virologic failures, was achieved in 98.4%. The univariable analysis demonstrated the significantly lower response rates in males, patients with liver cirrhosis, decompensation of hepatic function at baseline, documented esophageal varices, concomitant diabetes, body mass index ≥25, and previous ineffective antiviral treatment. Despite an overall very high effectiveness, some unfavorable factors, including male gender, genotype 3 infection, liver cirrhosis, and treatment experience, significantly reduce the chances for a virologic response were identified.