Pangenotypic Hepatitis C Therapy with Direct Acting Antivirals: A Southern Nigeria Pilot Experience

Background: Viral hepatitis C (HCV) is a global health challenge affecting at least 3.3% of the world population. Sub-Saharan Africa still battles with under diagnosis, and poor access to diagnostic facilities occasioned by a lack of manpower/facilities to treat infected persons bringing about an increase in HCV-associated morbidity and mortality. The goal of this prospective observational study is to assess the efficacy of sofosbuvir/daclatasvir (SOF/DAC) combination as a pangenotypic treatment for hepatitis C without HCV genotype determination in patients with hepatitis C attending the hepatology clinic at the Rivers State University Teaching Hospital (RSUTH).

Method: One hundred and fifty (150) HCV RNA positive patients were enrolled into the study. Their sociodermographic factors, clinical and laboratory parameters including pre and post treatment HCV RNA were assessed. Treatment eligible patients received sofosbuvir 400mg and daclatasvir 60/90mg for 12 weeks which was extended to 24 weeks in patients with decompensated liver disease. Treatment success was defined as undetectable HCV RNA 12 weeks after completion of therapy (SVR-12).

Results: One hundred and nine (109) of the 150 recruited patients were eligible for treatment. The male to female ratio of the study population was 1.1:1(79, 52.7%):71,49.3%) with a mean age of 47.78±13.39 years. Eighty-six (86,78.9%) of the 109 treated patients had undetectable HCV RNA at SVR-12 and this was most likely to occur in patients with low viremia (OR=2.52, 95%CI=0.985-6.436, p=0.050). Extension of treatment duration played no apparent role in the achievement of SVR-12 (SVR-12=33.3%), however, previously treated HCV patients had a better outcome.

Conclusion: Sofosbuvir/ daclatasvir pangenotypic therapy is effective for treatment of HCV patients without genotyping.