HCV genotype 4 subtypes in people who inject drugs in sub-Saharan Africa

Abstract

We read Fredrick Kateera and colleagues’ Article on hepatitis C virus (HCV) treatment in Rwanda with great interest. 1 Kateera F Shumbusho F Manirambona L et al. Safety and efficacy of sofosbuvir–velpatasvir to treat chronic hepatitis C virus infection in treatment-naive patients in Rwanda (SHARED-3): a single-arm trial. Lancet Gastroenterol Hepatol. 2022; 7: 533-541 Summary Full Text Full Text PDF Scopus (4) Google Scholar Of the estimated 58 million people worldwide with HCV, 9 million live in sub-Saharan Africa. 2 WHOGlobal progress report on HIV, viral hepatitis and sexually transmitted infections 2021. Accountability for the global health sector strategies, 2016–2021: actions for impact. World Health Organization, Geneva2021 Google Scholar Genotype 4 is the most prevalent HCV genotype in much of sub-Saharan Africa, including the central and eastern subregions. 3 Polaris Observatory HCV CollaboratorsGlobal prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol. 2017; 2: 161-176 Summary Full Text Full Text PDF PubMed Scopus (1381) Google Scholar Due to genotype 4's phylogenetic diversity, several subtypes—particularly 4r—have higher rates of resistance-associated substitutions (RASs) before treatment than other subtypes. Additionally, there is a lower threshold for acquisition of RASs in non-a and non-d subtypes than other genotype 4 subtypes after treatment failure with ledipasvir-based and daclatasvir-based regimens. The first SHARED study showed a clear reduction in sustained virological response rate with sofosbuvir–ledipasvir among participants with genotype 4r (56% vs 93% for participants with subtypes other than 4r). 4 Gupta G Mbituyumuremyi A Kabahizi J et al. Treatment of chronic hepatitis C virus infection in Rwanda with ledipasvir–sofosbuvir (SHARED): a single-arm trial. Lancet Gastroenterol Hepatol. 2019; 4: 119-126 Summary Full Text Full Text PDF PubMed Scopus (49) Google Scholar In the SHARED-3 study, reported by Kateera and colleagues, sustained virological response was 97% using sofosbuvir–velpatasvir, 1 Kateera F Shumbusho F Manirambona L et al. Safety and efficacy of sofosbuvir–velpatasvir to treat chronic hepatitis C virus infection in treatment-naive patients in Rwanda (SHARED-3): a single-arm trial. Lancet Gastroenterol Hepatol. 2022; 7: 533-541 Summary Full Text Full Text PDF Scopus (4) Google Scholar providing crucial data on an effective treatment option for harder-to-treat subtypes. Safety and efficacy of sofosbuvir-velpatasvir to treat chronic hepatitis C virus infection in treatment-naive patients in Rwanda (SHARED-3): a single-arm trialA 12-week regimen of sofosbuvir–velpatasvir is safe and efficacious in treating chronic HCV genotype 4 infection in patients in Rwanda. This regimen could be an effective treatment option in regions known to have a high prevalence of HCV genotype 4 of diverse non-a/d subtypes. Full-Text PDF