Efficacy And Safety Of Direct-acting Antiviral Agents In Treatment Of Hepatitis C Cirrhosis

Objective In this study we aim at investigating the efficacy and safety of DAA in the treatment of chronic hepatitis C,and providing the basis for the treatment of chronic hepatitis C.Participants and Methods We selected 111 patients who were diagnosed with hepatitis C cirrhosis,and all patients were from the outpatient department of the First Affiliated Hospital of Guangxi Medical University between 2016.01-2018.09,they met the inclusion and exclusion criteria of this study.Patients with different genotypes were treated with different DAAs.The therapeutic regimen for genotype 1 patients is: sofobuvir(SOF)+daclatasvir(DCV)12/24 weeks?SOF+ ledipasvir(LDV)12 weeks?SOF +ribavirin(RBV)24 weeks?SOF+ velpatasvir(VEL)12 weeks?asunaprevir(ASV)+ DCV 24 weeks?SOF+interferon 12 weeks?SOF+PR 12 weeks?ombitasvir/ paritaprevir /ritonavir+ dasabuvir(3D)12 weeks?danoprevir(ASC08)+PR+ritonavir(RTV)12 weeks;the therapeutic regimen for genotype 2 patients: SOF+ RBV 12 weeks?SOF+DCV 12 weeks;and the genotype 3:SOF+RBV 24 weeks?SOF+DCV 12/24 weeks?SOF+VEL 12 weeks;genotype 6:SOF+PR 12 weeks?SOF+DAC 12 weeks?SOF+VEL 12 weeks?SOF+LDV 12 weeks?SOF+RBV 24 weeks.we collected laboratory examination results of these patients,such as HCV genotype,HCVRNA viral load,liver and kidney function,blood routine examination.we used statistical software to analyze these datas.At week 4,the end of the treatment(ETVR),and 12 ? 24 weeks after withdrawal,we calculated the virological response rate of patients with different genotypes,compared the efficacy and adverse reactions of different DAAs.Results 1?Among the 111 patients,68 were male and 43 were female,with an average age of 44.95±11.56 years old.55 were genotype 1(3 cases of type 1a and 52 cases of type 1b),3 were genotype 2,19 were genotype 3(8 cases of type 3a and 11 cases of type 3b),19 were genotype 6a,and 15 were undetermined genotypes.2?Virological responses of different genotypes:the RVR rates of genotype 1 patients were 90.2%,and the ETVR,SVR12 and SVR24 rates were all 100%;the RVR,ETVR,SVR12 and SVR24 rates of genotype 2 patients were all 100%;the RVR,ETVR,SVR12 and SVR24 rates of genotype 3 patients were: 100%,100%,89.5% and 89.5%;the RVR,ETVR,SVR12 and SVR24 rates of genotype 6 patients were all 100%.3?Virological response of different treatment regimens:The total RVR rate was 91.8%,the ETVR was 100%,and the SVR12 and SVR24 rates were both 98.2%;The RVR rates of SOF+PR and SOF+IFN were 0,and the rates of ETVR,SVR12 and SVR24 were 100%;The rates of RVR,ETVR,SVR12 and SVR24 of SOF+VEL were 94.7%,100%,95.5%,95.5%;The rates of RVR,ETVR,SVR12 and SVR24 of SOF+DCV were 91.9%,100%,97.6%,97.6%;The RVR,ETVR,SVR12 and SVR24 rates of SOF+RBV,SOF+LED,ASM+DCV,3D,ASC08+PR+RTV were all 100%.4?The RVR,ETVR,SVR12 and SVR24 rates of previously untreated patients were 92.9%,100%,97.6%,97.6%.In the patients who had failed the previous PR treatment,the rate of RVR was 88.9%,and the ETVR,SVR12 and SVR24 rates were all 100%.Highly sustained virological response rates were achieved in both groups,the difference was not statistically significant(P > 0.05).5? The RVR,ETVR,SVR12 and SVR24 rates were 95.7%,95.9%,100%,98.9% and 98.9% respectively in patients with hepatitis C cirrhosis;the RVR rate of patients with non-cirrhosis was 90.9%,and their ETVR,SVR12 and SVR24 rates were all 100%.patients who were hepatitis C cirrhosis or not could obtain highly sustained virological response rate,the difference was not statistically significant(P > 0.05).6?After antiviral treatment with DAAs regimen,the liver function of the patients was significantly improved.The value of AST and ALT after treatment was lower than before treatment,P<0.001.7?During the period of treatment,there were 12 cases of adverse reactions in 111 patients,including 5cases of hematological abnormalities,3 cases of fatigue,2 cases of dizziness and 2 cases of emotional agitation.During the medication period,none of the patients had abnormal renal function,and none of them terminated treatment because of significant adverse reactions.Conclusion 1.All kinds of DAAs have good therapeutic effects in the treatment of chronic hepatitis c,with SVR12 reaching 98.2%,few adverse reactions and high safety.2.The SVR12 of DAAs in patients with genotype 3 is lower than that of other genotypes,the therapeutic effect may be improved by adding RBV or extending the course of medication.3.DAAs can significantly improve the liver function of patients with chronic hepatitis C.4.Whether patients were initial treatment or treat-experienced,with cirrhosis or non-cirrhosis,DAAs was very effective on them.