Direct antiviral therapy for treatment of hepatitis C: A real-world study from Brazil

Lobato, Cirley Maria de Oliveira; Codes, Liana; Silva, Giovanni Faria; Souza, Aécio Flávio Meirelles de; Coelho, Henrique Sérgio Moraes; Pedroso, Fiona L.; Parise, Edison Roberto; Lima, Leila Maria Soares Tojal de Barros; Borba, Luiz Augusto; Evangelista, Ana Catarina Jorge; Rezende, Rosamar Eulira Fontes; Cheinquer, Hugo; Kuniyoshi, Aline Satie Oba; Aires, Rodrigo Sebba; Quintela, Eloiza Helena Dias; Mendes, Liliana Sampaio Costa; Nascimento, Fabio Carneiro Vosqui; Filho, José Eymard Moraes de Medeiros; Ferraz, Maria Lúcia Cardoso Gomes; Abdala, Edson; Bittencourt, Paulo Lisboa

doi:10.1016/j.aohep.2019.08.001

Cited by 34 publications

(36 citation statements)

References 29 publications

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“…Overall, our results are similar to those recently reported by smaller studies conducted in the LatAm region analyzing only one DAA regimen 5‐11 . In the first report of the LALREAN registry, including 900 patients from Brazil and Argentina, the overall SVR12 rate with SOF/DCV ± RBV was 96.1% (95% CI, 94.6‐97.2%).…”

Section: Discussionsupporting

confidence: 89%

Decompensated cirrhosis and liver transplantation negatively impact in DAA treatment response: Real‐world experience from HCV‐LALREAN cohort

Ridruejo

Piñero

Mendizábal

et al. 2020

Journal of Medical Virology

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Introduction Although the effectiveness of direct‐acting antivirals (DAAs) for the treatment of chronic hepatitis C virus (HCV) has been reported in real‐world settings, predictive factors of treatment failure are lacking. Therefore, we sought to explore the baseline predictors of treatment response to DAAs. Methods This was a prospective multicenter cohort study from the Latin American Liver Research Educational and Awareness Network (LALREAN) including patients who received DAA treatment from May 2016 to April 2019. A multivariate logistic regression model was conducted to identify variables associated with unachieved sustained virological response (SVR), defined as treatment failure (odds ratios [OR] and 95% confidence intervals [CIs]). Results From 2167 patients (55.2% with cirrhosis) who initiated DAA therapy, 89.4% completed a full‐course treatment (n = 1938). Median treatment duration was 12 weeks, and 50% received ribavirin. Definitive suspension due to intolerance or other causes was observed in only 1.0% cases (n = 20). Overall non‐SVR12 was 4.5% (95% CI, 3.5‐5.7). There were no significant differences in treatment failure according to HCV genotypes and the degree of fibrosis. Independently associated variables with DAA failure were liver function impairment according to the Child‐Pugh score B OR, 2.09 (P = .06), Child‐Pugh C OR, 11.7 (P < .0001); and liver transplant (LT) recipient OR, 3.75 (P = .01). Conclusion In this real‐life setting, higher DAA treatment failure rates were observed in patients with decompensated cirrhosis and in LT recipients. These predictive baseline factors should be addressed to individualize the appropriate time‐point of DAA treatment (NCT03775798; http://www.clinicaltrials.gov).

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Section: Discussionsupporting

confidence: 89%

Decompensated cirrhosis and liver transplantation negatively impact in DAA treatment response: Real‐world experience from HCV‐LALREAN cohort

Ridruejo

Piñero

Mendizábal

et al. 2020

Journal of Medical Virology

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“…Higher SVR rate was observed among women. This finding is comparable to other studies [6,14,15] where SVR rate varied by gender with males having lower HCV cure rate. The factors account for this difference are not well understood.…”

Section: Discussionsupporting

confidence: 89%

High sustained viral response among HCV genotype 3 patients with advanced liver fibrosis: real-world data of HCV elimination program in Georgia

et al. 2020

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Objective: In 2015, Georgia launched HCV elimination program. Initially, patients with advanced liver disease were treated with sofosbuvir-based regimen-the only DAA available for all genotypes. Purpose of the study was assessing real-world data of treatment outcome among patients with HCV GEN3 and advanced liver fibrosis with sofosbuvirbased regimens. Results: Totally 1525 genotype 3 patients were eligible for analysis; most (72.6%) were aged > 45 years, majority were males (95.1%), and all (100%) had advanced liver disease (F3 or F4 by METAVIR score based on elastography). Of those who received sofosbuvir/ribavirin (SOF/RBV) for 24 weeks, 79.3% achieved SVR, while 96.5% who received sofosbuvir/ pegylated interferon/ribavirin (SOF/PEG/RBV) for 12 weeks achieved SVR (p < 0.01). Among patients with liver cirrhosis (defined as F4) overall cure rate was 85.7% as opposed to 96.4% for those with F3. Females were more likely to be cured (98.7% vs 89.7%; OR = 8.54). Patients aged 31-45 years had higher likelihood of achieving SVR compared to patients aged 46-60 years (95.7% vs 87.4%; OR = 0.32,). Independent predictors of SVR were treatment with SOF/PEG/ RBV (aOR = 6.72) and lower fibrosis stage (F3) (aOR = 4.18). Real-world experience among HCV GEN3 patients with advanced liver fibrosis and treated by sofosbuvir regimen w/o PEGIFN, demonstrated overall high SVR rate.

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“…Studies have indicated that protease inhibitors induce rapid selection of resistant viral variants, but the combination of protease inhibitors with other drugs (e.g., interferon-alpha and ribavirin) has indicated a significant improvement in the sustained virological response rate [11][12][13]. In Brazil, drugs, such as boceprevir, telaprevir, simeprevir, and sofosbuvir, are provided at no cost to people infected with HCV who have liver fibrosis or cirrhosis [14].…”

Section: Introductionmentioning

confidence: 99%

Hepatitis C Virus among Female Sex Workers: A Cross-Sectional Study Conducted along Rivers and Highways in the Amazon Region

et al. 2019

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Background: Previous studies found a high prevalence of pathogens among female sex workers (FSWs) in the Amazon region, and established their parenteral and sexual transmission. This study estimated the prevalence of hepatitis C virus (HCV) infection and associated risk factors, and the frequency of HCV genotypes and resistance-associated substitutions (RASs) in this vulnerable group. Methods: Distinct sampling methods were used to access 412 FSWs in cities and riverside communities in the Amazon region from 2015 to 2018. Three methods for HCV diagnosis were used to determine infection status. HCV genotypes and RASs were identified by sequencing and nucleotide fragment analysis. An association between HCV infection and exposure factors was determined by bivariate and multivariate analysis. Results: In total, 44 (10.7%) FSWs were exposed to HCV, and 32 (7.8%) of them had active infection. Nine socioeconomic characteristics and risky sexual behaviors were associated with HCV exposure, particularly unprotected sex and condom exemption for the clients who paid extra money. Genotype 1 (81.3%) and 3 (18.7%) were detected. The frequency of FSWs with RASs was 23.1% (6/26) for grazoprevir related to the occurrence of substitutions Y56F and S122G. Conclusions: HCV infection among FSWs is highly prevalent and dominated by genotype I. Urgent preventive and treatment measures are required to reduce HCV infection in FSWs and the general population.

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Direct antiviral therapy for treatment of hepatitis C: A real-world study from Brazil

Cited by 34 publications

References 29 publications

Decompensated cirrhosis and liver transplantation negatively impact in DAA treatment response: Real‐world experience from HCV‐LALREAN cohort

Decompensated cirrhosis and liver transplantation negatively impact in DAA treatment response: Real‐world experience from HCV‐LALREAN cohort

High sustained viral response among HCV genotype 3 patients with advanced liver fibrosis: real-world data of HCV elimination program in Georgia

Hepatitis C Virus among Female Sex Workers: A Cross-Sectional Study Conducted along Rivers and Highways in the Amazon Region

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