A recent study (R Esteban et al. Gastroenterol 20018; 155: 1120-7) evaluated the efficacy of sofosbuvir and velpatasvir in patients with hepatitis C genotype 3.

Overall, the study shows good efficacy of this regimen with and without ribavirin, though with higher SVR12 and lower relapse with the addition of ribavirin.

The difference in response was driven almost entirely based on whether there were pretreatment NS5A resistance-associated substitutions (RASs) present.

• In those with NS5A RASs the difference in response with added ribavirin compared to without was 96% vs 84%.
• In those without NS5A RASs the difference in response with ribavirin compared to without was 99% vs. 96%.

My take:

• If RAS testing is available and baseline Y93H is absent, then ribavirin is not likely needed
• Genotyping is still important.  The associated editorial (pg 969-71) labeled genotype 3 ‘the problem child in the era of direct-acting antivirals.”   That is, there are still differences in treatment recommendations based on HCV genotype.

Related blog posts:

• HCV Guidelines
• An “Ally” for Hep C Genotype 3
• A New Villain for Hepatitis C | gutsandgrowth
• Understanding HCV Treatment Failures with Sofusbuvir …