Effectiveness of Retreatment with ombitasvir/paritaprevir/ ritonavir, dasabuvir+sofosbuvir+ribavirin in Patients with Chronic Hepatitis C, Subtype 1b and Cirrhosis, Who Failed Previous with First- and Second-generation NS5A Inhibitors

Abstract

The use of Direct�Acting Antiviral agents (DAAs) in patients with chronic HCV GenoType (GT) 1 infection results in Sustained Virologic Response (SVR) rates of 95%-97%, but 3%-5% of patients experience virologic failure. We observed 41 patients infected with HCV subtype 1b who failed previous treatment with DAAs, including 37 subjects (90.2%) with liver cirrhosis. In total, 30(73.2%) subjects previously received NS5A inhibitors of the first generation (ledipasvir, daclatasvir, or ombitasvir) and 11 subjects (26.8%) received NS5A inhibitors of the second generation (velpatasvir). All patients received retreatment with a combination of ombitasvir/paritaprevir/ritonavir and dasabuvir (3D) with Sofosbuvir (SOF) and Ribavirin (RBV). We compared SVR12 rates depending on fibrosis stage, presence of just single or double NS5A mutation (L31M/V/I and/or Y93H), and the generation of previously used NS5A inhibitors. Observed SVR12 rates were as follows: 97.6% (40/41 patients) overall; 100% in patients without cirrhosis (n=4) versus 97.3% in those with cirrhosis (n=37); 100% with single L31M/V/I or Y93H mutation (n=22) versus 94.4% with double mutations (n=18); 100% in patients who failed previous treatment with first�generation (n=30) versus 90.9% in those who failed previous treatment with second�generation NS5A inhibitors (n=11).