Efficacy,prognosis And Factors Influencing The Treatment Of Genotype 3 Chronic Hepatitis C With DAAs In A Real-world Setting In Yunnan

Objective To analyze the epidemiological characteristics of genotype 3 hepatitis C in Yunnan Province and seek better screening protocols for hepatitis C.To observe liver function,T lymphocytes,cytokines and HCV RNA load before and after SOF/VEL±RBV treatment of hepatitis 3 patients,with a view to providing reference for the treatment of hepatitis 3 patients and seeking predictors of treatment response in HCV-infected patients.Methods Demographic and clinical data of genotype 3 CHC patients who attended the Third People’s Hospital of Kunming from 2017 to 2022 treated with the SOF/VEL±RBV regimen were retrospectively collected.The efficacy,prognosis and factors influencing the treatment of genotype 3 CHC with SOF/VEL±RBV were analyzed by statistical methods such as one-way difference test and multi-factor regression analysis.Results1.Epidemiological features and clinical characteristics of patients with genotype 3CHC There were 797 male patients and 329 female patients with genotype 3a hepatitis C.There were significantly more male patients than female patients,with the largest number of patients in the 40-49 age group.The occupations of the patients were mainly unemployed(418 cases,),farmers(202 cases)and self-employed(148 cases).30 of the336 genotype 3a patients had a history of drug use;45 of the 790 genotype 3b patients had a history of drug use.In the whole cohort,there were mostly HCV infection alone(80.11%),co-infection with HBV in 42 patients(3.73%),co-infection with HIV in 177 patients(15.72%)and co-infection with HBV,HCV and HIV in 5 patients(0.44%).1126 patients included 578(51.3%)with chronic hepatitis,286(25.4%)with compensated cirrhosis,160(14.2%) with decompensated cirrhosis,83(7.4%)with liver failure and 102(9.1%)with hepatocellular carcinoma.286 cases(25.4%),160 cases of decompensated cirrhosis(14.2%),83 cases of liver failure(7.4%)and 102 cases of hepatocellular carcinoma(9.1%).In this study,2% to 23.2% of the patients were combined with various other chronic diseases.the rate of abnormal AFP was higher in the GT3 b group than in the GT3 a group;platelets counts were lower in the GT3 b group than in the GT3 a group.Factors such as indirect bilirubin,globulin,alanine aminotransferase,and the presence of combined decompensated cirrhosis or AIDS affect HCV RNA load.2.Immunological profile of patients with genotype 3 CHC The absolute numbers of CD3+ T cells,CD4+ T cells and CD8+ T cells were higher in the chronic hepatitis group than in the decompensated cirrhosis group.IL-5,IL-6,IL-8,IL-10,IL-12p70 and IL-17 levels were higher in compensated cirrhosis group than in chronic hepatitis group.Patients in the compensated cirrhosis group had higher IL-5,IL-10,IL-12p70 than those in the decompensated cirrhosis group.There was no significant difference in the absolute number of T lymphocytes in the chronic hepatitis group,the compensated cirrhosis group and the decompensated cirrhosis group before and after SOF/VEL±RBV treatment.In terms of cytokines,IL-12p70 was significantly lower at the end of treatment in the chronic hepatitis group than before treatment.IL-6,IL-8 and IL-17 were significantly lower at the end of treatment in the compensated cirrhosis group compared to the pre-treatment period.3.Efficacy of SOF/VEL±RBV regimen in treating patients with genotype 3 CHC The SVR12 rate in 92 patients with HCV infection was 93.5%(86/92).Conclusion1.Genotype 3 HCV infection in Yunnan Province is influenced by demographic characteristics such as gender,age and occupation.2.Patients with genotype 3 CHC in this study had a high rate of co-morbidity with other diseases and attention needs to be paid to the occurrence of drug interactions when using anti-HCV treatment with DAAs.3.Combined testing of multiple indicators such as indirect bilirubin,globulin,alanine aminotransferase,and the presence of combined decompensated cirrhosis or AIDS in patients with hepatitis C would be more helpful in determining disease progression.4.T-lymphocyte subsets and cytokine levels change significantly during the progression of chronic hepatitis C to cirrhosis.5.The SOF/VEL±RBV regimen is effective in treating genotype 3 hepatitis C patients without cirrhosis or in compensated cirrhosis;however,the SOF/VEL±RBV regimen is less effective in treating genotype 3 hepatitis C patients with decompensated cirrhosis.6.Compared with pre-treatment,peripheral blood IL-12 in patients in the chronic hepatitis group and IL-6 and IL-8 in patients in the compensated cirrhosis group decreased significantly after SOF/VEL±RBV treatment;while no significant changes were seen in T lymphocyte subsets.