1042 Direct-Acting Antivirals for the Treatment of Hepatitis C Genotypes 1 to 5 in Sub-Saharan Africa

Abstract

INTRODUCTION: The use of direct-acting antivirals (DAAs) for the treatment of hepatitis C virus infection (HCV) has exposed the possibility of global elimination of the virus worldwide. However, a large number of HCV-infected individuals reside in resource-limited settings such as sub-Saharan Africa (SSA). There is very limited knowledge of the use of DAAs in SSA METHODS: We developed a single-arm prospective study to assess response to DAAs in 164 individuals infected with HCV genotypes 1 to 5 in Addis Ababa, Ethiopia. The majority of patients were treated with Ledipasvir/Sofosbuvir (LDP/SOF) with or without Ribavirin (RBV) or Sofosbuvir with Ribavirin (SOF/RBV). Before initiation of treatment, every patient underwent an abdominal ultrasound, evaluation of liver function markers and calculation of aspartate transaminase to Platelet Ratio Index (APRI) to determine fibrosis status. HCV RNA levels were determined at baseline and 12 weeks after end of treatment. RESULTS: HCV treatment with DAAs was completed by all 164 enrolled individuals. The median age of patients was 52 years (IQR 42-60) and 55% of them were females. Seventy-six percent of individuals had genotype 4, 14% genotype 2, 6% genotype 1, 2.5% genotype 5 and 1.5% genotype 3. The median HCV RNA level before treatment was 1.300.555 IU/L (IQR: 649825-3182800), and the median APRI score was 1.49 (IQR 1.13-2.24) with 19 % of participants showing evidence of cirrhosis on imaging. Sixty-seven percent of patients were treated using LDP/SOF, 18.5% using LDP/SOF/RBV and 14.6% using SOF/RBV, all for a total of 12 weeks. The sustained virologic response (SVR) rate across all genotypes was 98.8%. In those individuals with cirrhosis, SVR was 93.5% and in non-cirrhotics 100% regardless of APRI-based fibrosis level. Two patients failed to achieve SVR. Both showed evidence of decompensated cirrhosis and one had failed previous therapy with interferon. Among reported side effects, fatigue was the most commonly reported at 11%, followed by nausea in 1.2% of subjects. All side effected subsidized after end of treatment. CONCLUSION: Our study demonstrates for the first time successful treatment of HCV with DAAs among different viral genotypes in Sub-Saharan Africa, demonstrating the feasibility of HCV elimination in resource-limited settings.