Direct Acting Antiviral Treatment Response in Chronic Hepatitis C Infection: Data From Tertiary Care Center in South India

Abstract

Background and Aim: To assess the prevalence of HCV genotypes in southern India and the response to treatment with directly acting antivirals (DAA). Methods: The study was conducted between June 2015 and December 2016. 82 patients with chronic HCV infection visiting PSG Hospital, Coimbatore in southern India were treated as per EASL HCV treatment recommendations 2015 with available DAAs in India as follows: (1) Sofosbuvir(SOF) + Ribavirin(RBV) ± pegylated Interferon α(PEG-IFNα), (2) Ledipasvir(LDV) + SOF ± RBV, (3) Daclatasvir(DCV) + SOF ± RBV. Treatment was decided as per the patient's HCV genotype, extent of liver disease, previous treatment exposure status and contraindications. Results: HCV genotype 4 (58%) was the most prevalent, followed by genotypes 3 (21%), 1 (18%) and 2 (1%). One case was of indeterminate genotype. The overall response to Sofosbuvir (SOF)/Ribavirin (RBV) ± pegylated interferon (PEG-IFNα), Ledipasvir (LDV)/SOF ± RBV and Daclatasvir (DCV)/SOF ± RBV treatment across all genotypes showed SVR12 of 88.6% (n = 44), 96.6% (n = 29) and 100% (n = 9), respectively. SOF/RBV ± PEG-IFNα has shown better results in treating GT-1 and GT-4 infections in non-cirrhotics in south India than what most western studies have observed. The response to SOF/RBV ± PEG-IFNα in compensated and decompensated cirrhotics across all genotypes was 86.9% (n = 23) and 60% (n = 5) respectively, which was poor compared to LDV/SOF ± RBV or DCV/SOF ± RBV treatment. In one case of GT-3 infection treated with DAA, patient progressed to HCC 1 year after achieving SVR with persistent undetectable HCV RNA. Conclusion: GT-4 was the most prevalent HCV genotype in southern India. SOF + RBV ± PEG-IFNα may still have a role in treating GT-1 and GT-4 non-cirrhotics, but LDV + SOF ± RBV in GT-1 and GT-4 infections, and pan-genotypic DCV + SOF ± RBV have the best response in chronic HCV infection in southern India. The authors have none to declare.