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

• Main Authors: Cirley Maria de Oliveira Lobato, Liana Codes, Giovanni Faria Silva, Aécio Flávio Meirelles Souza, Henrique Sérgio Moraes Coelho, Maria Lucia Alves Pedroso, Edison Roberto Parise, Leila Maria Soares Tojal de Barros Lima, Luiz Augusto Borba, Andreia Silva Evangelista, Rosamar Eulira Fontes Rezende, Hugo Cheinquer, Aline Satie Oba Kuniyoshi, Rodrigo Sebba Aires, Eloiza Helena Dias Quintela, Liliana Sampaio Costa Mendes, Fábio Carneiro Vosqui Nascimento, José Eymard Moraes de Medeiros Filho, Maria Lúcia Cardoso Gomes Ferraz, Edson Abdala, Paulo Lisboa Bittencourt, Adalgisa de Souza Paiva Ferreira, Juan Miguel Villalobos Salcedo, Leonardo de Lucca Schiavon, Edmundo Pessoa de Almeida Lopes, Mário Guimarães Pessôa, Luciana Lofêgo Gonçalves, Francisco José Dutra Souto, Elodie Bomfim Hyppolito, Gustavo Henrique Santos Pereira, Angelo A. Mattos, Rita de Cássia Martins Alves Silva, Ana de Lourdes Candolo Martinelli, Claudia Alexandra Pontes Ivantes, Carlos Eduardo Brandão Mello, Geisa Perez Medina Gomide, Hoel Sette Junior, Paulo de Tarso Aparecida Pinto, Fernando Gomes Romeiro, José Milton de Castro Lima, Isaac Altikes, André Castro Lyra, Raquel Francine Liermann Garcia, Cristiane Alves Villela-Nogueira, Renata Cruvinel Cabral Cuminale, Andrea Magalhães Agra de Omena, Janaina Luz Narciso Schiavon, Andrea Doria Batista, Rafaela de Liz Pellegrim Sanchez Lermen, Gabriela Perdomo Coral, Raymundo Paraná, Cristiane Valle Tovo, Débora Raquel Benedita Terrabuio, Norma Arteiro Filgueira, Francisco Sergio Rangel de Paula Pessoa, Fernando Antônio Barreiros de Araújo, Edna Strauss, Cristina Melo Rocha, Paulo Roberto Abrão Ferreira, Nilma Lucia Sampaio Ruffeil
• Format: Article
• Language: English
• Published: Elsevier 2019-11-01
• Series: Annals of Hepatology
• Subjects: Chronic hepatitis C; Direct antiviral agents; Hepatic fibrosis; Cirrhosis
• Online Access: http://www.sciencedirect.com/science/article/pii/S1665268119322197
• ISSN: 1665-2681

Introduction and objectives: Direct antiviral agents (DAAs) including sofosbuvir (SOF), daclatasvir (DCV), simeprevir (SIM) and ombitasvir, paritaprevir and dasabuvir were introduced 2015 in Brazil for treatment of hepatitis C virus (HCV) infection. The aims of this study were to assess effectiveness and safety of HCV treatment with DAA in real-life world in a highly admixed population from Brazil. Materials and methods: All Brazilian reference centers for HCV treatment were invited to take part in a web-based registry, prospectively conducted by the Brazilian Society of Hepatology, to assess outcomes of HCV treatment in Brazil with DAAs. Data to be collected included demographics, disease severity and comorbidities, genotype (GT), viral load, DAA regimens, treatment side effects and sustained virological response (SVR). Results: 3939 patients (60% males, mean age 58 ± 10 years) throughout the country were evaluated. Most had advanced fibrosis or cirrhosis, GT1 and were treated with SOF/DCV or SOF/SIM. Overall SVR rates were higher than 95%. Subjects with decompensated cirrhosis, GT2 and GT3 have lower SVR rates of 85%, 90% and 91%, respectively. Cirrhosis and decompensated cirrhosis in GT1 and male sex and decompensated cirrhosis in GT3 were significantly associated with no SVR. Adverse events (AD) and serious AD occurred in 18% and 5% of those subjects, respectively, but less than 1% of patients required treatment discontinuation. Conclusion: SOF-based DAA regimens are effective and safe in the heterogeneous highly admixed Brazilian population and could remain an option for HCV treatment at least in low-income countries.