Journal
JOURNAL OF HEPATOLOGY
Volume 74, Issue 6, Pages 1472-1482Publisher
ELSEVIER
DOI: 10.1016/j.jhep.2021.03.004
Keywords
Hepatitis C virus; direct-acting antiviral agents; rescue treatment; resistance-associated variants (RAVs); resistance-associated substitutions (RASs); antiviral therapy
Categories
Funding
- research grant Deutsches Zentrum fur Infektionsforschung (DZIF), TTU Hepatitis
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Viral resistance is a major factor in virological failure of patients with chronic HCV infection receiving DAAs treatment, with the importance varying based on DAA regimen and HCV genotype. First-line therapy with G/P or VEL/SOF may not require baseline resistance analysis, while VOX/VEL/SOF is the preferred second-line treatment option. Different patient subgroups may benefit from resistance testing to optimize therapy.
Viral resistance is a major reason for virological failure in patients being treated with direct-acting antivirals (DAAs) for chronic HCV infection. However, the importance of viral resistance mainly depends on the DAA regimen and HCV genotype. For first-line therapy with glecaprevir/pibrentasvir (G/P) or velpatasvir/sofosbuvir (VEL/SOF) no general baseline resistance analysis is required because of the high antiviral activity and high barrier to resistance. If available, resistance testing may help to optimise therapy in certain subgroups of patients with HCV genotype 3 and other rare HCV geno/subtypes. Voxilaprevir/velpatasvir/sofosbuvir (VOX/VEL/SOF) is the first choice for the second-line treatment of patients following a previous DAA failure, with rates of viral eradication above 90% irrespective of the presence of resistance-associated substitutions (RASs). However, in resource-limited settings, only first generation DAAs may be available for second-line therapy. Here, RASs selected during initial antiviral therapy should be considered if testing is available and rescue treatment should include a switch to a regimen with a new DAA class to optimise treatment response. Patients with HCV genotype 3 are overrepresented in the group who experience DAA treatment failure. Limited data are available for third line therapies, but promising results have been achieved with G/P plus SOF or VOX/VEL/SOF with or without ribavirin for 12 to 24 weeks; these regimens should be administered irrespective of a patient's RAS profile. (C) 2021 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
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