Abstract
Background
The majority of HCV infections are found in low- and middle-income countries, harboring many region-specific HCV subtypes. Nevertheless, direct-acting antivirals (DAA) trials were almost exclusively conducted in high-income countries, where mainly epidemically spread HCV subtypes are present. Recently, several studies demonstrated sub-optimal DAA efficacy for certain non-epidemic subtypes, which could hamper global HCV elimination. Therefore, we aimed to evaluate DAA efficacy in patients treated for a non-epidemic HCV genotype infection in the Netherlands.
Methods
We performed a nationwide retrospective study including patients treated with interferon-free DAA for a HCV genotype other than 1a/1b/2a/2b/3a/4a/4d. Genotype was determined by NS5B-region phylogenetic analysis. Primary endpoint was SVR-12. If stored samples were available, NS5A and NS5B sequences were obtained for resistance-associated substitutions (RAS) evaluation.
Results
We included 160 patients, mainly infected with non-epidemic genotype 2 (41%) and 4 (31%) subtypes. Most patients originated in Africa (45%) or South America (24%); 51 (32%) were cirrhotic. SVR-12 was achieved in 92% (140/152) of patients with available SVR-12 data. Only 73% (8/11) genotype 3 infected patients achieved SVR-12, the majority being genotype 3b patients with 63% (5/8) SVR. Regardless of SVR, all genotype 3b patients had 30K and 31M RAS.
Conclusions
DAA efficacy in most non-epidemic genotypes in the Netherlands seems reassuring. However, the low SVR-12 rate in subtype 3b infections is alarming, especially as it is common in several HCV endemic countries. Alongside earlier results, our results indicate that a remaining challenge for global HCV elimination is confirming and monitoring DAA efficacy in non-epidemic genotypes.
Increased case‐finding and uptake of direct‐acting antiviral treatment essential for micro‐elimination of hepatitis C among people living with HIV: a national record linkage study
