Treatment Failure with Direct Antiviral Agents in Patients with Hepatitis C Virus Genotype 1 Infection at the Veteran Affairs Caribbean Healthcare System in San Juan, Puerto Rico

Abstract

Objective: We performed a descriptive study of patients who have failed to DDAs in our Veteran population. The primary outcome of this study is to describe the clinical profile of these patients and to evaluate their respective resistance mutation panel. Methods: This investigation is a descriptive retrospective study of patients with chronic hepatitis C between the ages of 21 to 89 years from the Veteran Affairs Caribbean Healthcare System in P.R. Eligible cases were Veterans treated for hepatitis C with second generation of DAAs from January 1, 2015 to December 31, 2016 who failed to therapy. Patient records were reviewed and those who met inclusion criteria were included. Results: Among Hispanic Veterans treated with DAA for genotype 1 HCV infection, 3.9% had failure to treatment with the second generation DAAs. 90% were genotype 1a; while 10% were 1b. 80% of these were identified as cirrhotic and the other 20% were non cirrhotic. 90% had resistant variants for Ns5a. Eight patients had Ns3 RASs testing requested of which 50% had presence of resistant variants. Five patients had Ns5b RASs testing performed of which 40% had positivity for resistant variants to Ns5b. Conclusion: Despite DAA effectiveness, phase III clinical trials with new IFN-free DAA-based therapies have a 5-7% treatment failure rates. Real-life data has showed that <15% of patients fail to achieve SVR in the most difficult to cure groups such as those with cirrhosis or subtype 1a. These findings are comparable with our current study.