| Objective:To evaluate the efficacy,safety and tolerability of the direct antiviral drug sorfombuvir/vipatavir in combination with or without ribavirin in patients with genotype 3 chronic hepatitis C and hepatitis C cirrhosis in Yunnan Province,China;To analyze the factors influencing the rate of hepatitis C viral load decrease and the sustained virological response.Methods:Choose between January 2018 and June 2020 in the third people’s hospital outpatient service in kunming,yunnan province,and admission office database genotype 3 patients with chronic hepatitis c and hepatitis c cirrhosis compensatory period,a total of 179 cases,using oral direct antiviral drugs wei/d palmer he wei suo phosphorus cloth or not plus ribavirin treatment for 12 weeks,follow-up of 12 weeks after the drug was stopped.Among them,112 cases of patients with chronic hepatitis c giving Mr Wei/d p cloth he wei treatment,67 cases of patients with chronic hepatitis c with compensatory cirrhosis giving Mr Wei/d p cloth he wei plus ribavirin treatment,clinical baseline characteristics analysis of two groups of patients,evaluate the effectiveness of the direct antiviral treatment,safety,and tolerability,To analyze the influencing factors of the rate of HCV load decrease and the sustained virological response.Biochemical indicators were detected by automatic AU400 biochemical analyzer manufactured by Olympus,Japan.Hepatitis C viral load was detected by automatic Amperprep/Cobas-Taqman48 system detector manufactured by Roche,Switzerland(the detection limit was 12IU/mL).Liver hardness was determined by FibroScan502 ultrasonic diagnostic instrument(normal value is less than 6.4kPa)produced by Echosens,France.A sustained virological response was defined as a patient who stopped treatment at 12 weeks and had HCV RNA below the detection limit after 12 weeks of follow-up.Statistical Methods:The measurement data conforming to normal distribution were expressed as mean±standard deviation(x±s),and the Student t test was used.The enumeration data were expressed as case number and rate,and the chi-square test was used for comparison.Spearman correlation analysis was used for influencing factors of the decreasing speed of viral load of patients.Univariate and multivariate regression analyses were used to determine the factors influencing patients’ sustained virological response,and P<0.05 was considered statistically significant.Results:Of the 179 patients at baseline,162 had HCV RNA≥6.01g IU/mL and 67 had LSM≥14.6kPa.All patients were treated with SOF/VEL±RBV for 12 weeks.HCV RNA in all patients was lower than the lower limit of detection when the drug was stopped.After 12 weeks of follow-up,6 patients recurred,and SVR12 was 96.6%.The decrease rate of HCV RNA during treatment was correlated with the liver hardness at baseline(p=0.213,P=0.001).The lower the baseline LSM,the faster the decrease rate of HCV RNA.After receiving SVR,ALT in the CHC group decreased from(98.6±65.4)IU/L at baseline to(31.1±1.3)IU/L,AST decreased from(74.6±52.8)IU/L to(30.5±1.3)IU/L,TBil decreased from(22.8±24.5)μmol/L to(19.2±0.8)μmol/L,and LSM decreased from(11.1±4.7)kPa to(5.2±0.7)kPa.ALT in the LC group decreased from(93.5±57.3)IU/L at baseline to(31.5±5.3)IU/L,and AST decreased from(83.7±41.2)IU/L to(32.8±2.7)IU/L.TBil decreased from(25.3±18.9)μmol/L to(19.7±1.8)μmol/L,and LSM decreased from(17.7±9.4)kPa to(9.4±1.2)kPa.Both CHC and LC groups had SVR above 95%,and univariate and multivariate regression analyses showed that baseline retreatment or cirrhosis was a high risk factor for failure to obtain SVR12.During the treatment,the adverse drug reactions of the patients were slight,mainly including fatigue and headache,occasional nausea,insomnia and diarrhea,etc.,all of which were mild,most of which were transient,and the symptoms would gradually disappear after rest.Conclusion:Based on real world experience,this study retrospectively analyzed that SOF/VEL±RBV in the treatment of genotype 3 hepatitis C cirrhosis patients in Yunnan Province,China can achieve high SVR,improve the patients’ biochemical indicators and liver fibrosis,and have good safety and tolerability.The lower the baseline LSM value,the faster the HC V RNA decline during treatment,and the faster the HCV RNA decline may further shorten the course of treatment.Patients with cirrhosis or retreatment are independent risk factors for failure to achieve a sustained virological response during antiviral therapy. |
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