Ribavirin For Chronic Hepatitis Research Articles

THU-220 - Sofosbuvir/Velpatasvir plus Ribavirin for chronic hepatitis C virus genotype 3 infected cirrhotic patients with or without HIV or HBV coinfection: real-world experience from southwest China

THU-220 - Sofosbuvir/Velpatasvir plus Ribavirin for chronic hepatitis C virus genotype 3 infected cirrhotic patients with or without HIV or HBV coinfection: real-world experience from southwest China

Teaching Neuro Images : Hypertrophic olivary degeneration in a young man with POLG gene mutation

A 30-year-old man with sensorineural hearing loss presented with subacute somnolence, slurred speech, and unsteady gait following treatment with peginterferon α-2b and ribavirin for chronic hepatitis C virus. Examination revealed scanning speech, horizontal nystagmus, gait ataxia, and symmetric hyporeflexia with distal sensory loss. There was no palatal myoclonus. Metabolic and serologic workup and blood lactate were unrevealing. Brain MRI demonstrated bilateral hypertrophic olivary degeneration (HOD, figure). Whole exome sequencing identified a homozygous pathogenic p.W748S POLG mutation.1 Differential diagnosis of bilateral HOD includes mutations in the nuclear genes crucial to mitochondrial function, POLG and SURF1 .2

Treatment of Hepatitis C Disease with Standard Therapy and its Correlation with Specific Genotype of Interleukin

Aim: To determine the association of interleukin-28b- RS12980275 with response to treatment with interferon α-2b & ribavirin in chronic hepatitis c patients Methodology: A case control study was designed that includes219 HCV patients treated with INF and Ribavirin. Out of 219, 95 were males while 124 were females. They are classified into two groups. Those achieved sustained virological response (SVR) and those who did not sustained virological response (Non-SVR). All the demographics and biochemical data were recorded on a Performa that includes age, ALT and viral load. The data were analyzed using SPSS version 16.0. Results: Patients having IL28B-rs12980275 AG genotypes respond better to interferon and ribavirin treatment (p-value=0.01, OR=2.91). Furthermore, HWE was also calculated for both groups in which the responders do not corresponds to HWE (p-value= <0.001) while the non-responders were found to be consistent with HWE (p-value= 0.31). Conclusion: Polymorphism in IL28B (rs12980275) was found to be significantly associated (p-value = 0.009) with the treatment outcome in patient with hepatitis C receiving standard therapy regimen (Interferon + Ribavirin). Key words: Hepatitis C, polymorphism, Interferon

The Impact of IL28B Gene Polymorphisms on Drug Responses

The Impact of IL28B Gene Polymorphisms on Drug Responses

Treatment of interferon treated relapsers and non- responder chronic hepatitis C cases with Directly acting antivirals

To determine the response rate to sofosbuvir and ribavirin in chronic Hepatitis C Virus (HCV) patients who did not respond or relapsed with interferon therapy. A case series study was performed at Jinnah Postgraduate Medical Centre (JPMC), Karachi from January 2017- January 2019. HCV RNA positive were initiated in eligible patients with sofosbuvir 400mg once daily and ribavirin 400mg orally according to body weight for six months. Rapid viral response (RVR) [normal/undetectable ALT and AST level or very low HCV RNA at 4-6 weeks]. HCVRNA, CP, ALT were checked after 3 months of stopping treatment to confirm sustained virologic response (SVR). Of 100 cases, 16 (16%) were non-responders while relapse was observed in 84 (84%) patients. Among the 13 cirrhosis patients, 11 (84.6%) achieved SVR. Females had a significantly higher response rate as compared to males (p value 0.034). The sustained virological response rate in interferon treated chronic hepatitis C patients retreated with sofosbuvir and ribavirin was found satisfactory. &nbsp

BENEFIT OF ADDING SOFOSBUVIR TO INTERFERON AND RIBAVIRIN IN RETREATING CHRONIC HEPATITIS C PATIENTS NOT RESPONDING TO INTERFERON AND RIBAVIRIN

Background: Worldwide, more than one million people die each year from hepatitis C virus (HCV) related diseases, and over 300 million people are chronically infected with hepatitis B or C. Objective: Studying the benefit of adding sofosbuvir to pegylated interferon and ribavirin in chronic hepatitis C patients not responding to interferon and ribavirin as regards virological response and liver fibrosis regression. Patients and methods: A prospective study was conducted in cooperation with AL-AgouzaPoliceHospital. The enrolled patients were classified into two groups: Group (A): one hundred and fifty naive patients with chronic HCV infection, and group (B): one hundred and fifty patients with chronic HCV infection who were non responders to prior treatment with pegylated interferon and ribavirin after at least 6 months of this treatment. Enrolled patients were treated using interferon (IFN) based regemin that included Pegylated INF alpha + ribavirin (weight based; 1200 mg if ≥ 75 Kg or 1000 if < 75 Kg of body weight) + sofosbuvir (400 mg/day for 12 weeks) according to National Committee for Control of Viral Hepatitis (NCCVH) hepatitis C treatment protocol update, May 2015. PCR was done 4 weeks after starting treatment (RVR), at the end of treatment (ETR), 12, 24, 48 weeks after the end of treatment to assess virological response in both groups. Fibroscan was done before treatment and 12-24 weeks after the end of treatment to assess liver fibrosis. Results: Of the 300 patients included, SVR12 was achieved in 275 patients (92%), SVR24 and SVR48 in 267 patients (89%). There was a statistically significant difference between both studied groups as regards SVR12, SVR24 and SVR48 where group (A) showed better virological response than group (B). Regression of fibrosis was achieved in both groups, and there was a statistically significant difference as regards pre-treatment and post-treatment fibroscan score in both groups. Conclusion: Adding Sofosbuvir to Interferon and Ribavirin in retreating chronic hepatitis C patients not responding to Interferon and Ribavirin improved the response of treatment and caused regression of liver fibrosis.

BENEFIT OF ADDING SOFOSBUVIR TO INTERFERON AND RIBAVIRIN IN RETREATING CHRONIC HEPATITIS C PATIENTS NOT RESPONDING TO INTERFERON AND RIBAVIRIN

Background: Worldwide, more than one million people die each year from hepatitis C virus (HCV) related diseases, and over 300 million people are chronically infected with hepatitis B or C. Objective: Studying the benefit of adding sofosbuvir to pegylated interferon and ribavirin in chronic hepatitis C patients not responding to interferon and ribavirin as regards virological response and liver fibrosis regression. Patients and methods: A prospective study was conducted in cooperation with AL-AgouzaPoliceHospital. The enrolled patients were classified into two groups: Group (A): one hundred and fifty naive patients with chronic HCV infection, and group (B): one hundred and fifty patients with chronic HCV infection who were non responders to prior treatment with pegylated interferon and ribavirin after at least 6 months of this treatment. Enrolled patients were treated using interferon (IFN) based regemin that included Pegylated INF alpha + ribavirin (weight based; 1200 mg if ≥ 75 Kg or 1000 if < 75 Kg of body weight) + sofosbuvir (400 mg/day for 12 weeks) according to National Committee for Control of Viral Hepatitis (NCCVH) hepatitis C treatment protocol update, May 2015. PCR was done 4 weeks after starting treatment (RVR), at the end of treatment (ETR), 12, 24, 48 weeks after the end of treatment to assess virological response in both groups. Fibroscan was done before treatment and 12-24 weeks after the end of treatment to assess liver fibrosis. Results: Of the 300 patients included, SVR12 was achieved in 275 patients (92%), SVR24 and SVR48 in 267 patients (89%). There was a statistically significant difference between both studied groups as regards SVR12, SVR24 and SVR48 where group (A) showed better virological response than group (B). Regression of fibrosis was achieved in both groups, and there was a statistically significant difference as regards pre-treatment and post-treatment fibroscan score in both groups. Conclusion: Adding Sofosbuvir to Interferon and Ribavirin in retreating chronic hepatitis C patients not responding to Interferon and Ribavirin improved the response of treatment and caused regression of liver fibrosis.

Thyroid disturbances in children treated with combined pegylated interferon-alpha and ribavirin for chronic hepatitis C.

BackgroundImmunomodulatory properties of interferon (IFN) have been documented. It may induce autoimmune diseases such as autoimmune thyroiditis with hypo- or hyperthyroidism. In addition, it may impair thyroid hormone synthesis through affecting iodide organification in thyroid gland.PurposeThe aim of this study was to describe thyroid function tests disturbances in children with chronic hepatitis C (CHC) receiving pegylated interferon-alpha (PEG IFN-α) plus ribavirin.MethodsFifty children with CHC virus infection who received combined pegylated interferon-alpha with ribavirin were selected. Other 50 apparently healthy children of matched age and sex (considered as control group) were selected. All children (100) were subject to liver function tests, virological studies, and follow-up of thyroid function test during and after the treatment course.ResultsOur study showed that 28% of children received combined PEG IFN-α plus ribavirin showed subclinical hypothyroidism. After 24 weeks treatment with combined therapy of IFN plus ribavirin, the mean level of thyroid stimulating hormone (TSH) was 3.23±88 mU/mL, while TSH was 1.16± 0.77 mU/mL before starting treatment. On the other hand, mean TSH was 1.09±0.92 mU/mL in normal control group.ConclusionThis study revealed an association between subclinical thyroid dysfunction and treatment with IFN-alpha and ribavirin in children. Further studies on larger number of patients and longer follow-up duration are recommended for further confirmation.

Efficacy and safety of Paritaprevir/Ritonavir + Ombitasvir ± Dasabuvir ± Ribavirin in chronic hepatitis C patients with chronic renal failure

Efficacy and safety of Paritaprevir/Ritonavir + Ombitasvir ± Dasabuvir ± Ribavirin in chronic hepatitis C patients with chronic renal failure

Evaluation of cost-effectiveness of peginterferon plus ribavirin for chronic hepatitis C treatment and direct-acting antiviral agents among HIV-infected patients in the prison and community settings.

In Taiwan, the majority of chronic hepatitis C carriers with HIV co-infection are intravenous drug users and inmates in correctional facilities. Peginterferon and ribavirin (PegIFN/RBV) have been the standard-of-care for chronic hepatitis C virus (HCV) infection more than decades. We evaluated the estimated cost-effectiveness of PegIFN/RBV from the National Health Insurance Research Database, covering the population of Taiwan from 1998 to 2013. This is an observational study, and study during was 2010-2016 and a total of 239 patients were treated with PegIFN/RBV. Of them, 156 patients were treated in the correctional facilities of Taipei, Taoyuan, Taichung and Taitung prisons, and 83 patients were treated in communities. The cost-effectiveness was analyzed in regimens of PegIFN/RBV and direct-acting antiviral agents. By multivariate analysis, the patients completed PegIFN/RBV in prison (adjusted odds ratio [aOR]: 4.56, 95% confidence interval [CI]: 1.58-13.12, p=0.005), HCV RNA level <800,000IU/mL (aOR: 4.0, 95% CI: 1.27-12.66, p=0.02) at baseline, and the presence of early virologic response (EVR) (aOR: 7.67, 95% CI: 1.89-31.06, p=0.004) were independent predictors for sustained virologic response (SVR). For the subgroups of prisoners, HIV-infected prisoners and HIV-infected patients in communities, the SVR rate was 73.8%, 72.0% and 36.8%, and the average medical-care cost was US$7,701, $7,893, and $15,443 per SVR achieved, respectively. Also, the estimated medical-care cost for genotype 6 was US$9211. Chronic HCV/HIV co-infected patients with genotype 1 and 6 in the community setting could benefit from DAAs in Taiwan.

Effect of a vegetarian diet on the treatment efficacy of peginterferon plus ribavirin in chronic hepatitis C patients: A retrospective cohort study

The aim of the study was to compare the treatment efficacy of peginterferon plus ribavirin on vegetarian vs omnivorous (nonvegetarian) patients with chronic hepatitis C infection. Two hundred and fifty-four hepatitis C virus (HCV) viremic patients with elevated alanine aminotransferase (ALT) levels, who received peginterferon plus ribavirin therapy were included in this study. Sixty-one patients (24.0%) were vegetarians and 193 patients (76.0%) were omnivores. We analyzed the sustained virological response (SVR) and compared the data between the two treatment groups using a logistic-regression model. Other possible confounding factors such as age, gender, body mass index, HCV genotype, pretreatment ALT levels and HCV viral count, type of peginterferon used, and status of cirrhosis, coronary heart disease, hypertension, and diabetes mellitus were also included in the analysis. SVR was demonstrated in 77% of the vegetarian cohort (47 out of 61 patients) and 76.2% of the omnivorous cohort (147 out of 193 patients). In the multivariate logistic-regression analysis, we found that a vegetarian diet was not associated with an increased protection against an SVR (odds ratio [OR] 1.35; 95% confidence interval [CI] 0.61-2.99). HCV genotype 1b (OR 0.51; 95% CI 0.27-0.98), ALT level (OR 1.01; 95% CI 1.00-1.01), cirrhotic (OR 0.20; 95% CI 0.08-0.49), and diabetic (OR 0.22; 95% CI 0.08-0.64) at pretreatment baseline were significantly associated with a clinical SVR. A vegetarian diet exerts no influence on the treatment efficacy of peginterferon plus ribavirin cotherapy among patients with chronic hepatitis C infection.

Post treatment failure of sofosbuvir plus ribavirin in chronic hepatitis C: 1 case of successful treatment of sofosbuvir combined with daclatasvir

Post treatment failure of sofosbuvir plus ribavirin in chronic hepatitis C: 1 case of successful treatment of sofosbuvir combined with daclatasvir

Discussion on optimal duration of pegylated interferon α combined with ribavirin for chronic hepatitis C in HIV-infected patients

Objective: To investigate the optimal duration of pegylated-alpha interferon (Peg-INFα) combined with ribavirin (RBV) in treating chronic hepatitis C infection in human immunodeficiency virus (HIV)-infected patients. Methods: A multicenter prospective study was conducted. The study subjects were divided into two groups; HIV/HCV co-infections (Group A, n = 158) and control with HCV-monoinfections (Group B, n = 60). All recruited patients received standard Peg-INFα plus RBV therapy. Group A was divided into 3 subgroups according to CD4(+) cell counts: A1 subgroup, 79 cases, CD4(+) counts > 350 cells /μl, who received anti-HCV before combination antiretroviral therapy(cART); A2 subgroup, 45 cases, CD4(+) counts between 200 and 350 cells/μl, who did not start anti-HCV until they could tolerate cART well; A3 subgroup, 34 cases, CD4(+) counts < 200 cells /μl, cART was administered first, and anti-HCV therapy was started when CD4(+) counts > 200 cells/μl. The anti-HCV efficacy of two groups and 3 subgroups were compared. Statistical analysis for normal distribution and homogeneity of variance data was calculated by t-test and the counting data was analyzed by χ (2) test. The Mann-Whitney U test was used for non-normal data. A one-way analysis of variance (ANOVA) was used for the comparison of multiple groups, followed by SNK method. Multiple independent samples were used for non-parametric tests. Results: There was no significant difference in age and baseline HCV RNA levels between groups and subgroups (P > 0.05). By an intent-to-treat (ITT) analysis, in Group A, the ratio of complete early virological response (cEVR) rate was 75.3% (119/158), the ratio of end of treatment virological response (eTVR) rate was 68.4% (108/158), and the ratio of sustained virological response (SVR) rate was 48.7% (77/158); in Group B, the ratio of cEVR rate was 93.3% (56/60), the ratio of eTVR rate was 90.0% (54/60), and the ratio of SVR rate was 71.7% (43/60); The therapeutic index of Group A were lower than those of Group B (P≤0.05). By per-protocol (PP) analysis, the ratio of cEVR rate in Group A [75.2% (88/112)] was still lower than that in Group B [93.3% (56/60)], but no significant differences were found in the ratio of eTVR rate and SVR rate between 2 groups (P > 0.05). Comparing the efficacy of subgroups (A1, A2 and A3) by ITT analysis, the ratios of cEVR rate were respectively 78.5% (62/79), 75.6% (34/45) and 67.6% (23/34); the ratios of eTVR rate were respectively 68.4%(54/79), 80.0%(36/45)and 52.9%(18/34); and the ratios of SVR rate were respectively 41.8%(33/79), 64.4%(29/45)and 44.1%(15/34). The ratio of eTVR in subgroup A2 was obviously higher than that in subgroup A3 and the ratio of SVR in subgroup A2 was statistically higher than that of subgroup A1(P≤0.05). However, by PP analysis, no significant differences of the therapeutic indexes were found among the respective subgroups (P > 0.05). Conclusion: HIV-HCV co-infected patients would have better anti-HCV efficacy with Peg-INFα-2a plus RBV than HCV- monoinfected patients. The best time for initiating anti-HCV therapy in HIV-HCV co-infected patients is when CD4(+) counts 200 cells/ μl.

A 3-year follow-up study after treatment with simeprevir in combination with pegylated interferon-\u03b1 and ribavirin for chronic hepatitis C virus infection

BackgroundSimeprevir is approved with pegylated interferon and ribavirin (PR) for chronic hepatitis C virus (HCV) genotype (GT) 1 and GT4 infection in the USA and the European Union.MethodsThis 3-year follow-up study assessed the durability of sustained virologic response (SVR) (undetectable HCV RNA 12 or 24 weeks after treatment end), and evaluated the persistence of treatment-emergent NS3/4A protease inhibitor resistance in patients not achieving SVR following treatment with simeprevir plus PR in the parent study. The maintenance of SVR after the last post-therapy follow-up visit of the parent study (LPVPS) was assessed using HCV RNA measurements. The persistence of treatment-emergent NS3 amino acid substitutions in patients with no SVR at LPVPS was assessed using population sequencing. No study medications were administered.ResultsOverall, 249 patients were enrolled (200 with SVR at LPVPS; 49 with no SVR at LPVPS); 40 patients discontinued prematurely (18 with SVR; 22 with no SVR). All 200 enrolled patients who achieved SVR in the parent study maintained SVR until the last available visit in this study (median follow-up time: 35.8 months). The treatment-emergent NS3 amino acid substitutions detected at time of failure in the parent study in 43/49 enrolled patients were no longer detected in 37/43 (86.0%) at the end of this study (median follow-up time: 179.9 weeks [41.3 months]).ConclusionThis 3-year follow-up study provides evidence for the long-term durability of SVR (100%) after successful treatment with simeprevir plus PR. Treatment-emergent NS3 amino acid substitutions became undetectable in the majority of patients.Trial registrationNCT01349465; ClinicalTrials.gov.

Effectiveness and safety of sofosbuvir/ledipasvir ± ribavirin treatment in liver and/or renal transplant patients with chronic hepatitis C: A single-center experience.

Objective:Successful treatment is possible with novel direct-acting oral antiviral agents in solid organ transplant patients with hepatitis C. In this study, the effectiveness and safety of sofosbuvir/ledipasvir ± ribavirin treatment in liver and/or renal transplant patients with chronic hepatitis C were evaluated.Materials and methods:A total of 23 liver and/or renal transplant patients who received sofosbuvir/ledipasvir ± ribavirin for chronic hepatitis C over 12 or 24 weeks were enrolled in the study. The treatment response, clinical and laboratory adverse effects, and effect on immunosuppressive drug levels were assessed.Results:A total of 12 patients had undergone renal transplantation and 11 had undergone liver transplantation. All of the renal transplant patients and 91% of liver transplant patients had genotype 1. In total, 10 renal transplant patients and 4 liver transplant patients had treatment experience. Two renal transplant patients and one liver transplant patient had compensated cirrhosis. Nine renal transplant patients were on tacrolimus, and two were on cyclosporine; all of the liver transplant patients were on tacrolimus-based immunosuppressive therapy. While hepatitis C RNA was negative in 75% of renal transplant patients and 91% of liver transplant patients at week 4, it was negative in all of the patients at the end of treatment and 12 weeks after treatment. Significantly reduced hemoglobin levels were observed in patients administered ribavirin during treatment (p = 0.01). There were no significant differences between the baseline and treatment period values of mean creatinine, estimated glomerular filtration rate, bilirubin, and tacrolimus levels. There were no adverse effects leading to treatment discontinuation.Conclusion:Sofosbuvir/ledipasvir ± ribavirin is quite safe and effective in hepatitis C treatment after liver and/or renal transplantation.

Assessment of auditory functions in chronic hepatitis C patients treated by sofosbuvir

ObjectiveEvaluating the auditory function in patients with chronic hepatitis C treated with sofosbuvir and ribavirin. MethodsThis study involved 80 patients with chronic hepatitis C who agreed to receive sofosbuvir and ribavirin. All participants were subjected to baseline otological and audiological assessment just before treatment. The audiological assessment included standard pure tone audiometry, extended high-frequency audiometry, immitancemetry and otoacoustic emissions (OAEs) (transient and distortion product). According to baseline hearing threshold measurements, the study population was divided into 2 groups. Group 1 included 42 patients with normal hearing sensitivity (250–8000 Hz), and Group 2 included 38 patients with sensorineural hearing loss. After 24 weeks of therapy, otological and audiological assessments were repeated and compared between the two groups and before and after therapy. ResultsPost-treatment hearing threshold evaluation showed no significant difference from pretreatment evaluation at all tested frequencies. There was no statistically significant difference between pre and post-treatment otoacoustic emissions results. ConclusionTherapy with sofosbuvir and ribavirin in chronic hepatitis C has no noticeable effects on cochlear functions.

The Effects of Interferon and Ribavirin in Chronic Hepatite C

The chronic hepatitis C is a frequently problem in worldwide, the number of infected individuals is high and go on, getting a public health problem [1]. In Romania there are nearly 1 million persons infected with hepatitis C virus, the scope of spreading is related with specific risk factors. An important number of infection with hepatitis C virus present simultaneous extrahepatic manifestations proved to be alone manifestation tracing; its important for diagnosis and treatment. We analyzed the effects of interferon and ribavirin in chronic hepatitis C in General C.F. Hospital Sibiu, between 2008 � 2012. The association between infection with hepatitis C virus and extrahepatic manifestations is important to be recognized for adequate diagnosis tests. By comparing the results of therapy in patients with hepatic and extrahepatic manifestations, the study found that 30 patients (58.83 %) with liver manifestations had an incomplete response versus 10 patients (26.32 %) with extrahepatic manifestations; 11 patients (21.54 %) with hepatic manifestations had a complete response versus 3 patients (7.89 %) with extrahepatic manifestations; and 10 patients (19.63 %) with hepatic manifestations did not respond to treatment versus 25 patients (65.79 %) with extrahepatic manifestations. Analyzing the results of antiviral therapy in patients with hepatic manifestations and those with extrahepatic manifestations, antiviral treatment appears to be more advantageous in cases with only hepatic manifestations.

Safety and efficacy of sofosbuvir plus velpatasvir with or without ribavirin for chronic hepatitis C virus infection: A systematic review and meta-analysis.

Velpatasvir is a newly FDA-approved inhibitor of hepatitis C virus (HCV) NS5A protein. We performed this systematic review and meta-analysis to investigate the safety and efficacy of velpatasvir plus sofosbuvir in the treatment of chronic HCV infection. A computerized literature search of PubMed, SCOPUS, EMBASE, EBSCO, Web of science, and Cochrane CENTRAL was conducted using relevant keywords. Data from eligible studies were pooled in a fixed effect meta-analysis model, using OpenMeta[Analyst] software. Pooled data from six randomized trials (n=1427 patients) showed that velpatasvir plus sofosbuvir achieved sustained virological response (SVR12) rates of 98.2% in genotype-1, 99.4% in genotype-2, 94.7% in genotype-3, 99.6% in genotype-4, 97.1% in genotype-5, and 98.8% in genotype-6 patients. The addition of ribavirin did not significantly increase the SVR12 (RR=0.95, 95%CI [0.88, 1.02]) or decrease relapse rates (RR=2.52, 95% CI [0.49, 12.87]) in HCV genotype-1 patients. However, adding ribavirin significantly increased SVR12 (RR=89.5, 95% CI [80.4, 99.5]) in genotype-3 patients. In conclusion, the 12-week regimen of sofosbuvir plus velpatasvir was highly effective in HCV patients, including those with cirrhosis and former treatment experience. Except for genotype-3, adding ribavirin was not associated with significant improvements in SVR12 rates. Further studies should investigate the effect of adding ribavirin to this regimen, especially in HCV genotype-3 patients.

Efficacy and safety of ledipasvir/sofosbuvir with ribavirin in chronic hepatitis C patients who failed daclatasvir/asunaprevir therapy: pilot study.

In Japan, daclatasvir (DCV) and asunaprevir (ASV) therapy was the first IFN-free treatment to be approved, and thousands of patients have since been successfully treated, with an SVR rate of around 90%. The converse, however, is that around 10% of patients fail to achieve viral eradication and must be retreated using a different approach. This study is to evaluate treatment efficacy of ledipasvir/sofosbuvir and ribavirin in patients who failed to respond to DCV and ASV therapy. Thirty patients were treated with 12weeks of ledipasvir/sofosbuvir and ribavirin. We evaluated the rate of sustained virological response 12weeks after the end of treatment (SVR12) and examined the incidence of adverse events during ledipasvir/sofosbuvir and ribavirin treatment. NS5A and NS5B resistance-associated variants (RAVs) in treatment failure cases were examined. The overall SVR12 rate was 86.7% (26/30). Large decreases in mean log10 HCV RNA levels were observed in patients without cirrhosis, and the SVR12 rate for these patients was 100% (12/12). In cases of cirrhosis, SVR12 rate was 72.2% (13/18). The common factors in treatment failure cases were the presence of liver cirrhosis and both NS5A L31M/I and Y93H RAVs. The frequency of RAVs did not change before and after treatment among patients who relapsed. Ledipasvir/sofosbuvir with ribavirin is an effective retreatment option for patients with chronic hepatitis C who failed to respond to prior daclatasvir and asunaprevir therapy.

Safety and effectiveness of response-guided therapy using pegylated interferon and ribavirin for chronic hepatitis C virus infection in patients on maintenance dialysis.

Treatment of hepatitis C virus (HCV) infection in patients with end-stage renal disease (ESRD) is difficult. Addition of ribavirin to pegylated-interferon (Peg-IFN) may help to improve the treatment response. Further, treatment duration could be shortened using a response-guided treatment (RGT) approach. We retrospectively reviewed records of treatment-naïve adult patients with ESRD and chronic HCV infection who had been treated with Peg-IFN and low-dose ribavirin using a RGT approach. Rapid responders (undetectable HCV-RNA at 4 weeks) received treatment for 12 weeks, and slow responders (HCV-RNA detectable at 4 weeks, but undetectable or with >2.0 log10 reduction at week 12) for 24 (genotype 3; GT3) or 48 (genotype 1; GT1) weeks. In those without such reduction (null responders), treatment was discontinued. Of 26 non-cirrhotic patients (GT1 15, GT3 11) treated, four (15%; GT1 3, GT3 1) were null responders. Twenty-two (85%) patients had either rapid (n = 14 (54%); GT1 10, GT3 4) or slow response (n = 8 (31%); GT1 2, GT3 6). Of them, 21 patients had undetectable RNA at the end of treatment; one could not complete the treatment and was lost thereafter. There were no deaths during treatment. Three patients relapsed and three others died in 6 months after stopping treatment. Overall, 15/26 (58%) patients attained SVR24. Fourteen patients underwent transplantation beginning one month after treatment completion, and all were relapse-free after 17 (14-24) months of follow-up. RGT using Peg-IFN and ribavirin was effective in ESRD patients on maintenance dialysis. Renal transplant was safely done within one month of completing such treatment.