Sustained Virologic Response in Chronic Hcv Infection with 4 Weeks of Anti-viral Therapy: 2027

Background: Over the last few years, the treatment of chronic hepatitis C infection has been transformed due to the introduction of the direct-acting antiviral agents (DAA), these medications have drastically increased the rate of sustained virologic response (SVR) compared to their interferon based predecessor. However, access to these medications is still limited due to the high cost. The current standard of care for treatment of chronic HCV in treatment naive individuals with genotype 1 infection, and no cirrhosis with a viral load of less than 6 million can be as short as 8 weeks of direct-acting antivirals (DAA). All other patients will require longer courses that range between 12 and 24 weeks. In this case series, we examine the characteristics of 5 patients who were lost to care and failed to receive their refills after receiving less than or equal to 4 weeks of DAA Methods: We identified all the patients who failed to receive the planned course of treatment over the last year in our hepatology clinic. Recorded all their baseline labs and characteristics with the available follow up outcomes. Results: All 5 patients who were identified received 4 weeks or less of DAA and all achieved SVR12 (100%). All patients were treatment naive. Four patients received 4 full weeks and one patient stopped after 1 week due to side effects. The mean age was 52.2 (40-65 years), 4 were female. 4 patients had genotype 1a, and one patient with 1b. Mean baseline HCV RNA was 1,228,251 copies/ml (7,531-3,795,000). All were HIV negative. None of the patients had any evidence of decompensated liver disease. 1 patient had compensated cirrhosis and the other 4 had early fibrosis (stages 1-2/4). The two patients who checked their HCV RNA at 2 weeks after initiating treatment had undetectable viral load. Four patients were treated with Sofosbuvir/Ledipasvir, and the patient who had cirrhosis was treated with Sofosbuvir/Ledipasvir and Ribavirin. Conclusion: High rate of SVR was achieved in our small sample when using 4 weeks of sofosbuvir based regimens in patients with GT 1. Larger studies especially on treatment naive, non-cirrhotic patients with low viral load could prove the efficacy of this regimen in selected patients. Shorter treatment course will have a great economic impact and increase the access to these medications.