Direct acting antivirals failure: cause and retreatment options

Expert Review of Gastroenterology & Hepatology
Lucia Parlati, Stanislas Pol

Abstract

Chronic hepatitis C (HCV) infection is a systemic life-threatening condition that can lead to hepatic and extra-hepatic complications. Sustained virological response (SVR) is associated with a regression of most liver and non-liver manifestations, which reduce mortality. The history of HCV infection therapy radically changed in the last decade, with the introduction of the first generation direct acting antivirals (DAAs). Areas covered: The new regimens, based on the combination of 2 or 3 second-generation DAAs, allow SVR, namely hepatitis C infection cure, in more than 95% of cases. Antiviral treatment is generally well tolerated and its duration (8-16 weeks) varies depending on the stage of liver fibrosis, HCV genotype, prior treatment, baseline viral load, presence of resistance-associated variants (RAV). This review evaluates the cause, the efficacy and safety results in case of DAAs failure. Expert commentary: Despite the excellent efficacy of DAAs, a minority of patients (4-5%) still fail to eradicate HCV, mainly related to poor adherence but also to relapse or viral breakthrough. The main causes of a failure of DAAs are the presence of advanced liver disease, suboptimal treatment and NS5A mutations. Many questions regard...Continue Reading

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Citations

May 6, 2020·PloS One·Felix PiechaJulian Schulze Zur Wiesch
May 5, 2020·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Saima AslamUNKNOWN working group members
Jul 31, 2021·World Journal of Gastroenterology : WJG·María B PisanoPamela Valva
May 21, 2021·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Caroline E BoekeChristian B Ramers
Jun 22, 2021·Antimicrobial Agents and Chemotherapy·Yanira Sáez-ÁlvarezMiguel A Martín-Acebes

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