Rescue therapy for chronic hepatitis C virus infection after repeated treatment failures: Impact on disease progression and risk of hepatocellular carcinoma

Abstract

Aim: Retreatment after previous failure of direct-acting antivirals for hepatitis C virus (HCV) infection is a challenging decision. The importance of achieving viral eradication on modification of disease progression and outcome, including the risk of hepatocellular carcinoma (HCC), remains a critical issue to be evaluated. Methods:One hundred patients with repeated failure of sofosbuvir and ribavirin or triple therapy with sofosbuvir, ribavirin, and daclatasvir were divided into a study group (n = 50) given rescue therapy (sofosbuvir, daclatasvir, simeprevir, and ribavirin) or a control group (n = 50) matched for age, sex, and pretreatment variables (Child-Turcotte-Pugh score and Fibrosis-4 score). Follow-up was undertaken after the last non-response to detect serious adverse events, such as hepatic decompensation and development of HCC. Results:The study group achieved sustained virologic response (SVR) in 47 of 50 (94%) patients. The control group had significantly higher HCC rates than the study group (7 vs. 1 patients), with an odds ratio of 5.44. The rescue therapy was associated with significantly longer time to the occurrence of adverse events. Repeated treatment failures were associated with progression of FibroScan values in the control group (21 ± 4.5 vs. 10 ± 1.5 kPa, P = 0.001); achieving SVR in the study group stopped fibrosis progression despite non-significant increase from baseline (13.2 ± 3.2 vs. 10.6 ± 0.6, P = 0.12). Conclusions:Rescue treatment for HCV infection was highly effective in achieving SVR, less expensive than the newer agents, and is associated with diminished risk of serious adverse events, mainly HCC in these patients.

Risk assessment of hepatocellular carcinoma development by magnetic resonance elastography in chronic hepatitis C patients who achieved sustained virological responses by direct‐acting antivirals

“…Hepatocellular carcinoma (HCC) is the leading cause of death in patients with chronic hepatitis C. In recent years, direct‐acting antiviral (DAA) treatment has enabled many patients to achieve sustained virological responses (SVR) . Thus, it is expected that the development of HCC will be suppressed .…”

“…Hepatocellular carcinoma (HCC) is the leading cause of death in patients with chronic hepatitis C. In recent years, direct-acting antiviral (DAA) treatment has enabled many patients to achieve sustained virological responses (SVR). [1][2][3][4][5][6][7] Thus, it is expected that the development of HCC will be suppressed. 8 However, some patients developed HCC even after the eradication of hepatitis C virus 9 ; therefore, it is clinically important to identify patients with a high risk of HCC development after SVR.…”

Biodegradability, flammability, dimensional stability, and UV resistance study of green wood starch gluten nanocomposites

“…The bacterial growth enhanced by the cellulolytic and pectinolytic activity of bacteria . Also, the lignin part of wood might be degraded by the bacterial strain . Besides this, starch is also a good source of food for the growth of bacteria.…”

Quadruple Therapy Offers High SVR Rates in Patients with HCV Genotype 4 with Previous Treatment Failure

“…It is worth mentioning that due to the limited availability of some newer DAAs in Egypt, the national committee for viral hepatitis management recommended treatment of hepatitis C patients for whom previous SOF/DCV-based regimens have failed with a combination of either SOF plus ritonavir boosted with paritaprevir and ombitasvir (OBV/ PTV/r) ± RBV or SOF plus simeprevir (SMV) and DCV ± RBV for 12 or 24 weeks according to RBV eligibility [19].…”

“…Unfortunately, treatment failure still occurs in about 5–15% of patients treated with DAA‐based combination regimens. Treatment failure of HCV may be the result of viral factors (HCV genotype and the presence of resistant variants), host factors (fibrosis and portal hypertension), and treatment-related factors (patient's adherence, duration of therapy metabolism of the drugs, and ribavirin use) [ 19 – 22 ].…”