Treatment of hepatitis C: the use of the new pangenotypic direct‐acting antivirals in “special populations”

Abstract

Background & Aims

The recommended combination of pangenotypic direct‐acting antivirals (DAAs) for the treatment of hepatitis C virus (HCV) associates the co‐formulation of 2 or 3 second‐generation DAAs. In the so‐called “special populations” defined as patients with chronic kidney disease (CKD), HCV/HIV co‐infection, HCV/HBV co‐infection and an unsuccessful previous DAA regimen, these combinations have a high antiviral potency (sustained virologic response (SVR) > 95%), fair tolerance and a reduced pill burden.

Methods

We have taken into account the scientific evidence on the treatment of “special populations”, in particular from the RUBY 1‐2 trials, EXPEDITION 2‐4 study, C‐WORTHY trial, ASTRAL 5, POLARIS 1‐4 studies, MAGELLAN 1 and REVENGE study.

Results

CKD and HCV/HIV co‐infection are not predictors of a non‐viral response. The glecaprevir/pibentrasvir (Maviret) combination appears to be the first‐line therapy for CKD patients while the sofosbuvir/vlpatasvir/voxaliprevir (Sovesi) combination is the first‐line option for DAAs failures. Both are effective in patients with HIV‐or HBV‐HCV co‐infection and should be chosen according to the potential drug‐drug interaction profile.

Conclusions

The notion of “special populations” is no longer pertinent with pangenotypic DAAs combinations. International guidelines recommend treating all infected patients and the next challenge is not the therapeutic choice, but to improve the limitations for screening and access to care in HCV infection.

 

KEYWORDS
DAA failures, direct‐acting antivirals, HBV‐HCV co‐infection, hepatitis C virus, HIV‐HCV co‐infection, kidney failure

 

About Speaker

Stanislas POL

Professor, MD, PhD

France

City: Paris

Institution: Hôpital Cochin

Contact: stanislas.pol@cch.aphp.fr


Biography of Stanislas POL

Dr. Stanislas Pol is Professor of Hepatology and Gastroenterology at Université Paris Descartes, Paris, France. He is the Head of the Liver department at Cochin Hospital, Paris, France. He attended an Hepatology and Gastroenterology residency, chief residency at the Necker-Enfants Malades University and molecular enzymology fellowship in Henri Mondor hospital. Dr Pol completed his MD thesis on hepatitis B virus occult infections in 1983 and his PhD thesis on the regulation of iso-enzymes of AST in liver disease in 1992. Dr. Pol’s research interests involve: 1. study of the impact of immune deficiency, including HIV, on the natural history of viral hepatitis; 2. the treatment of viral hepatitis and 3. reversal of cirrhosis. He is a co-head of a research Inserm unit studying the immune pathology of Hepatitis C virus infection (U1223 of Institut Pasteur).

He is the recipient of several research awards and fellowships. He has published more than 350 primary and review articles in the field of liver diseases. He has previously chaired the coordinated action 24 of the French Agency for AIDS and Viral Hepatitis (ANRS: therapeutic trials in viral hepatitis) and he is the clinical head of the French ANRS Hepather (HBV and HCV hepatitis) cohort. He is the director of the Center of Translationnal Research of Institut Pasteur since 2015.

View more