Causes of treatment failure for hepatitis C in the era of direct-acting antiviral therapy

Abstract

Hepatitis C therapy in the era of the newer direct-acting antiviral agents has radically changed our treatment schemes by achieving very high rates of sustained virological response. However, treatment with direct antiviral agents fails in a subgroup of patients. This group of so-called difficult-to-treat individuals is the subject of this paper, which reviews the causes of virological failure, their clinical implications, and some final recommendations.

Indian National Association for Study of the Liver (INASL) Guidance for Antiviral Therapy Against HCV Infection: Update 2016

“…26,27 Replication fitness refers to relative capacity of a viral variant to replicate in a given environment. 25 Though resistance profiles of currently available DAAs have been identified, there are no established standardized commercial assays for testing for resistance.…”

Eight weeks of Paritaprevir/r/Ombitasvir + Dasabuvir in HCV genotype 1b with mild‐moderate fibrosis: Results from a real‐world cohort

“…The treatment‐emergent resistance‐associated variant (RAV) analysis was available in 3 of 5 genotype 1b relapse patients, and two showed RAVs in NS3, NS5A or NS5B. Genotyping errors have been described to be responsible of a high number of DAA treatment failures . All except one relapse patient (with a low viral load) were regenotyped using new‐generation techniques.…”

“…Genotyping errors have been described to be responsible of a high number of DAA treatment failures. 33 Week 20 (SVR12) (n = 156) antiviral treatment. Therefore, this very rapid and significant effect of viral eradication on the improvement of liver function tests in patients without advanced fibrosis favours that these patients can be discharged after achieving sustained virological response.…”

Hepatite C

“…As terapias livres de interferon solucionaram a maioria dos problemas encontrados no curso da infecção pelo VHC. E mesmo sendo desejável a introdução dos DAAs no regime medicamentoso, algumas barreiras como o alto custo e a restrição de acesso a estes medicamentos podem ser obstáculos consideráveis 29,[56][57][58] .…”