novel genotypic variant combinations was examined using chimeric sub-genomic replicons. Results: Population sequencing of the NS3 protease and NS5A regions in all baseline isolates revealed the pre-existence of one PI-resistant variant (1a-NS3-K155; ~20-fold increase in BMS650032 EC50). In five of six GT1a patients experiencing VBT, emergent resistance variants to BMS-650032 included substitutions at either NS3–155 (R155K) or NS3–168 (D168E/T/Y). Emergent resistance variants to BMS-790052 included substitutions at NS5A-30 (Q30R), NS5A-31 (L31V/M), and NS5A-93 (Y93C/N). In one patient demonstrating VBT, HCVRNA levels were too low (<100 IU/mL) for analysis. In the one patient who did not respond to the addition of pegIFNa/RBV, the NS3 protease and NS5A resistance variants persisted 4 weeks post-treatment. The patient with a preexisting PI-resistant variant demonstrated rapid viral load decline and remained undetectable throughout the treatment period but relapsed at WK4 post-treatment. Two GT1b patients responded to 2-DAA treatment and demonstrated no relapse 4 weeks posttreatment. Conclusions: HCV NS3 protease and NS5A variants reported to confer resistance to BMS-650032 and BMS-790052, respectively, were selected in prior null responders infected with HCV GT1a during the 2-DAA treatment. These variants were detected at the time of VBT. No VBT was observed in patients infected with GT1b or receiving two DAA with pegIFNa/RBV.
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