Lower SVR Rates in Treatment Experienced Cirrhotic Veterans for Hepatitis C Genotype 1

Abstract

Introduction: Newer therapies for hepatitis C virus (HCV) genotype 1 produce high rates of sustained virologic response (SVR) in the general population. Not known is whether these therapies translate to a veteran population, with high HCV prevalence, and pleomorphic epidemiological environments such as alcohol, tobacco, obesity, homelessness, and substance abuse. This study assessed the SVR in such a population. Methods: A retrospective study was performed on all patients treated for HCV genotype 1 infection during the 2015 federal fiscal year at VA Loma Linda Health Care System (VALLHCS). Patients received 8, 12, or 24 weeks of daily therapy with ledipasvir-sofosbuvir (LDV/SOF) or ombitasvir-paritaprevirritonavir with dasabuvir (OPRD) with or without ribavirin (RBV) according to AASLD guidelines. All patients were evaluated for sustained virologic response at 12 weeks (SVR12) by serum quantitative PCR. Results: Ninety-seven patients were reviewed of which 55% received LDV/SOF, and 45% received OPRD therapy. Demographic analysis revealed that ninty-eight percent of patients were male, mean age 62, of which 25% were black, and 11% were Hispanic. Sixty-one percent had cirrhosis, 35% were treatment experienced, and 75% had HCV genotype 1a infection. All patients achieved virologic response during therapy, reaching an undetectable viral load by PCR. SVR12 was achieved in 93% of all patients (95% confidence interval [CI], 86-96). SVR12 was achieved in 100% of non-cirrhotic patients who received LDV/SOF+/-RBV (95% CI, 85-100), 94% of non-cirrhotic patients who received OPRD+/-RBV (95% CI, 72-99), 84% of cirrhotic patients who received LDV/SOF+/-RBV (95% CI, 67-93), and 96% of cirrhotic patients who received OPRD (95% CI, 82-99). The lowest SVR12 rate of 71% was observed in the treatment-experienced cirrhosis group who received LDV/SOF+RBV. The most common adverse effects included fatigue, headache, insomnia, and nausea.Figure 1Conclusion: New oral therapies for chronic HCV genotype 1 infections are effective in VA healthcare system patients with SVR12 rates comparable to the general population, except in treatment experienced cirrhotics. This group achieved a lower SVR12. Factors contributing may be the pleomorphic demographics of the VA population, which is pending further analysis.