Efficacy of direct-acting antivirals: UK real-world data from a well-characterised predominantly cirrhotic HCV cohort

Direct-acting antivirals (DAAs) have revolutionised the management of chronic hepatitisC virus (HCV) infection. We describe UK real-world DAA experience. Individualscommencing HCV treatment containing a DAA regimen (Mar 2014-Nov 2016),participating in the National HCV Research UK (HCVRUK) Cohort Study were recruitedfrom 33 UK HCV centers. The data were prospectively entered at sites onto acentralised database. The data were reported as median (Q1-Q3). Of the 1448 treatedpatients, 1054 (73%) were males, the median age being 54 years (47-60), 900 (62%)being genotype 1 and 455 (31%) genotype 3. The majority, 887 (61%) had cirrhosis, and590 (41%) were treatment-experienced. DAA regimens utilised: genotype1 sofosbuvir(SOF)/Ledipasvir/±Ribavirin (625/900, 69%) and Ombitasvir/Paritaprevir/Dasabuvir/±RBV (220/900, 24%), and in genotype 3 SOF/Daclatasvir + RBV (256/455, 56%) andSOF/pegylated interferon/RBV (157/455, 35%). Overall, 1321 (91%) achieved sustainedvirological response (SVR12), genotype 1 vs 3, 93% vs 87%, P < .001. Prior treatment,presence of cirrhosis and treatment regimen did not impact SVR12. Predictors oftreatment failure were genotype 3 infection, OR, 2.015 (95% CI: 1.279-3.176, P = .003),and male sex, OR, 1.878 (95% CI: 1.071-3.291, P = .028). Of those with hepaticdecompensation at baseline (n = 39), 51% (n = 20) recompensated post-treatment, lowerbaseline serum creatinine being associated with recompensation (P = .029). There weretwo liver-related deaths, both having decompensated disease. This real-world UK data,comprising of a predominantly cirrhotic HCV genotype 1/3 cohort, confirms DAAefficacy with an overall 91% SVR12, with 51% recompensating post-treatment.Genotype 3 infection was a predictor of treatment failure.