Efficiency and safety of direct acting antivirals in chronic hepatitis C patients ınfected with genotype 2 and 3 in Turkey

INTRODUCTION: Genotypes 2 and 3 chronic hepatitis C (CHC) patients are less frequently seen than genotype 1 in Turkey. While these genotypes have had favorable treatment outcomes with interferon-based regimens, response rates are lower with direct acting antivirals (DAAs). We aimed to evaluate efficiency and safety of DAAs in CHC patients infected with genotype 2 and 3. METHODS: Between April 2017 and September 2018, 37 centers recorded 2230 patients. All patients >18 years with CHC under DAAs were enrolled in this observational study. Those infected with genotype 2 and 3 were analyzed for end of treatment response (EoTR) and response at week 12 (SVR12). RESULTS: Among 2230 patients recorded into the database; 267 (12%) were infected with genotype 2 or 3, 73 (27%) were female and mean age was 41.7±17 years (range 18-84 years). The genotypes were 3 in 189 (71%) and 2 in 78 (29%). 25 (9.4%) had cirrhosis; 24 had compensated (Child-Pugh A) and 1 had decompensated (Child-Pugh B-C) cirrhosis. Liver biopsy was available in 151 (57%, G3: 107, G2: 44) patients; mean histologic activity index (HAI) was 7.4 and fibrosis score was 2.4. HAI was mild (1-6) in 37%, moderate (7-12) in 59%, and severe (13-18) in 4%. Fibrosis was mild in 49%, moderate in 47%, and advanced in 4%. While 200 (79%) patients were treatment-naive, 57 (21%) were previously treated with pegylated interferon+ribavirin: 74% relapse and 26% non-responder. Baseline viral load was 5.3x106 copies/mL. Ledipasvir + Sofosbuvir, Ledipasvir + Sofosbuvir + Ribavirin and Sofosbuvir + Ribavirin were given to 8, 15, and 154 patients, respectively. The drugs were tolerated well. Severe adverse events were not reported. SVR was evaluated in 134 patients, shown in Table 1. Response rate at week 4 was 119/147 (81%), EoTR 143/144 (%99.3%) and SVR12 128/134 (95.5%). CONCLUSION: This study represents the largest study of genotypes 2 and 3 CHC in Turkey. Genotype 3 is much commoner than genotype 2 (71% vs 29%). Rate of male gender was higher (73%) and mean age was 42 years. Liver histology showed moderate to higher activity in more than half of the patients and fibrosis was moderate to severe in half. Sofosbuvir and ribavirin containing regimens provided a SVR of more than 90%. The response rate in genotype 2 (94%) was lower than that in genotype 3 (96.5%). DAAs containing sofosbuvir and ribavirin have found efficient and safe among genotype 2 and 3 CHC patients in Turkey. *This study was supported by Gilead Sciences İlaç Ltd. Şti. (İstanbul, Turkey). Company was not involved to the content of the study/publication; no involvement to the decision to submit for publication.