HCV: should follow-up be extended to 72 weeks for SVR?

  • Pisaturo M & al.
  • Liver Int
  • 16 Dec 2018

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • Though uncommon, late relapse does occur among patients receiving HCV direct-acting antivirals (DAAs).

Why this matters

  • Findings suggest a posttreatment follow-up of 72 weeks rather than the commonly used 12 weeks posttherapy may be needed to confirm sustained virologic response (SVR).

Study design

  • Real-world multicenter Italian study of 129 HCV-infected patients (70.5% male; median age, 64 years) with nonresponse to interferon-free DAA therapy; 74.4% had cirrhosis.
  • Median duration of DAA therapy, 12 (range, 1-48) weeks.
  • Most had HCV-1b (41.9%) or HCV-3 (24.0%); HCV-1a (14.7%), HCV-2 (16.3%), and HCV-4 (3.1%) were also represented.
  • Funding: None.

Key results

  • 106 patients relapsed (82.2%), 15 (11.6%) were nonresponsive, and 8 (6.2%) had virologic breakthrough.
    • 9 of 15 patients with nonresponse received inappropriate DAAs per genotype.
  • Of 106 relapses, 99 (93.4%) occurred by week 12 posttherapy, and 7 (6.6%) occurred after week 12 (median, 24 weeks; 4 at week 24, 1 at week 48, and 2 at week 72).
    • Of 7 late relapses, 5 involved HCV-1b in patients with cirrhosis.
    • Baseline sequencing available for 2 patients showed no changes in NS3, NS5A, or NS5B regions — suggesting reactivation of the original strain.
    • Reinfection cannot be excluded in the remaining 5 patients.

Limitations

  • Small sample size.

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