Sofosbuvir/velpatasvir or glecaprevir/pibrentasvir for treating patients with hepatitis C virus reinfection following direct-acting antiviral-induced sustained virologic response

摘要

Data regarding the patient characteristics of hepatitis C virus (HCV) reinfection following viral eradication by a prior course of direct-acting antivirals (DAAs) and the clinical performance of pangenotypic DAAs to retreat such patients are lacking. The demographics and potential routes of transmission were shown in 22 patients with confirmed reinfection following HCV clearance by a prior course of DAAs. Twenty patients received retreatment with pangenotypic sofosbuvir/velpatasvir (SOF/VEL) or glecaprevir/pibrentasvir (GLE/PIB) according to label recommendations. The sustained virologic response (SVR12) rates and the tolerance following treatment were reported. The incidence rates of reinfection among human immunodeficiency virus (HIV)-positive and HIV-negative patients were 8.33 per 100 person-years (95 CI: 5.33-12.78) and 0.30 per 100 person-years (95 CI: 0.12-0.77), respectively. Eighteen (81.8) patients had HIV coinfection. The elapsed time between SVR12 and reinfection ranged from 3 to 36 months. Twenty (90.9) patients had different viral genotypes/subtypes before and after HCV reinfection. Prior to reinfection, 15 (68.2) patients achieved SVR12 using SOF/VEL or GLE/PIB. Twelve and eight patients were retreated with SOF/VEL for 12 weeks and GLE/PIB for 8 weeks, respectively, in whom SVR12 was all achieved. All patients completed the assigned course of retreatment without interruption and all had excellent tolerance. The risk of HCV reinfection is higher in HIV-positive patients than HIV-negative patients following DAA-induced SVR. Treating reinfected patients with SOF/VEL or GLE/PIB as DAA-naive patients has excellent effectiveness and tolerance, irrespective of the type of prior DAA exposure or viral genotypes/subtypes.