S1113 Management of Hepatitis C Genotype 4 Treatment Failure: A Real World Single Center Experience

Abstract

Introduction: Treatment failure with direct-acting antiviral (DAA) therapy is uncommon but it can be associated with significant worsening of liver disease especially in patients with liver cirrhosis. Retreatment of Hepatitis C (Hep C) patients who failed DAA therapy remains a challenge. Data on retreatment of HCV genotype 4 patients (G4) with DAA failure is limited and these patients are underrepresented in most clinical trials.The purpose of this study is to evaluate the efficacy of retreatment of HCVG4 DAA failure patients using a different DAA class from the currently available first-generation DAA regimens other than the regimen the patient had relapsed to. Methods: Out of 431 HCV G4 patients treated with DAAs in our center, 29 (6.7%) failed to achieve SVR. These patients were retreated by switching to a new DAA class from the first-generation DAA regimens independent of RAS testing. Twenty five out of these 29 patients completed retreatment regimen while 4 patients were lost for follow–up. Results: Among other risk factors, by logistic regression analysis, only older age, high CTP score and high base-line viral load were independent predictors of DAA failure among our cohort. Also, Sofosbuvir/Ribavirin regimen was the most common DAA regimen associated with treatment failure (48.3%). All our DAA failure patients had liver cirrhosis and ∼50% of them had advanced cirrhosis (Child´s class B or C), that made prompt retreatment of them a rescue strategy to halt viral replication and disease progression. After retreatment, 22 (88%) of the 25 patients who completed retreatment achieved SVR12 and the remaining 3 (12%) failed. The 3 patients who failed retreatment were all males, diabetics with advanced cirrhosis (mean CTP=9.33), and 2 of them were retreated by mistake with another drug from the same DAA class they had relapsed to (NS5A). These 3 patients completed a second retreatment, one patient achieved SVR and 2 patients relapsed for the second time (re-relapsers). Conclusion: The overall SVR rate (88%) demonstrated in this real–world study, clearly shows that, the retreatment policy of DAA failure patients by switching to or adding a new drug class independent of RAS testing is a good retreatment option that may be of importance for many areas of the world with no or difficult access to RAS testing or second-generation rescue regimens.