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Ribavirin Boosts HCV Genotype 3 Eradication in Compensated Cirrhotic Patients

Key clinical point: A combination of two direct-acting antivirals plus ribavirin produced the best cure rate for hepatitis C virus genotype 3 in cirrhotic patients.

Major finding: In compensated cirrhotic patients, sofosbuvir, velpatasvir, and ribavirin produced a sustained response rate of 98%.

Study details: A review of 14,603 English patients treated since the start of 2017.

Disclosures: Dr. Drysdale reported no disclosures.

Citation:

Drysdale K et al. J Hepatol. 2019 Apr;70(1):e131.

Commentary:

The results from Dr. Drysdale’s analysis confirm what had previously been proposed by other investigators that, in a subgroup of patients with cirrhosis and infected with hepatitis C virus (HCV) genotype 3, adding ribavirin to a regimen of direct-acting antiviral drugs can increase efficacy. But the new study included no data to address the prevalence of HCV genetic variants with resistance mutations that necessitate adding ribavirin. We have known that, in patients with cirrhosis and infected with resistant genotype 3 HCV, adding ribavirin is necessary. In many locations resistance testing is not possible; in those circumstances, adding ribavirin to the treatment should be routinely done.

It’s also been well known that the more advanced a patient’s liver disease, the harder it is to eradicate HCV infection. In general, patients with decompensated liver disease have sustained virologic response rates that are about 10% below the rate in patients without cirrhosis, and Dr. Drysdale reported a similar finding. This fact compels us to diagnose and treat HCV infections earlier. The current focus of the field is on screening for HCV infection among younger adults with risk factors for infection. Unfortunately, many people with an HCV infection are not in regular contact with their local health system, and in many parts of the industrialized world there is only weak practical support for comprehensive screening of at-risk people. Screening programs and recommendations exist, but today these are often ignored and higher-risk young adults frequently do not undergo HCV screening.

Thomas Berg, MD, is professor and head of hepatology at University Hospital in Leipzig, Germany. He has received personal fees and research support from several companies. He made these comments in an interview.