Abstract
Objective:To compare sustained viral response to sofosbuvir/ribavirin ±interferon therapy in patients of hepatitis C with and without liver cirrhosis.Methods:This observational study of chronic hepatitis C patients was carried out at Doctors Hospital and Medical Center (DH&MC). After diagnostic workup, Sofosbuvir/ribavirin for 24 weeks or sofosbuvir/ribavirin/pegylated interferon for 12 weeks were prescribed. Primary outcome was negative HCV RNA by PCR 12 weeks after treatment completion (SVR12). Chi square χ2 and student’s t test were used to analyze data.Results:Of 216 patients included, liver cirrhosis was present in 112 (51.9%) patients and 69(31.9%) were treatment experienced. Liver disease was decompensated in 37 (17.1%) patients. Of 206 patient who completed study protocol, 173(83.1%) achieved SVR12, 89.2% (25/28) with triple therapy and 82.2% (148/180) with sofosbuvir/ribavirin therapy. Treatment response was similar between treatment naïve 86.2% (119/138) and treatment experienced 79.4% (54/68) patents. (p value 0.19) SVR12 was inferior in cirrhosis patients 75.4% (80/106) as compared to those with no cirrhosis 93% (93/100) (p value < 0.000). It was even lesser in those with decompensated liver disease 68.8% (24/35) (p value < 0.000).Conclusion:Treatment outcome with sofosbuvir/ribavirin combination therapy in cirrhosis patients is suboptimal especially in those with decompensation as compared to patients without liver cirrhosis.
Highlights
Hepatitis C is among the leading causes of health related morbidity and mortality with ever rising incidence.[1]
Confirmed cases of chronic hepatitis C as determined by positive polymerase chain reaction (PCR) with lower limit of detection of 10 IU/ml were included after informed consent
Total of 216 patients were included in the study
Summary
Hepatitis C is among the leading causes of health related morbidity and mortality with ever rising incidence.[1] Due to its dreaded complications resulting in repeated hospitalization and need for liver transplantation, it consumes a major share of health related resources.[2]. Interferon based therapy was the only treatment option until few years back with its troublesome side effects and inadequate success rate. Introduction of directly acting antiviral (DAA) drugs has revolutionized management of hepatitis C.3. Sofosbuvir was the first nucleotide analogue which was effective without the need for interferon treatment.[4] It opened the gateway for so more DAAs with excellent treatment outcome.[5]
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