[Glecaprevir/Pibrentasvir + Sofosbuvir + Ribavirin as a salvage regimen after Sofosbuvir + Velpatasvir + Voxilaprevir re-treatment failure]

Abstract

Antiviral therapy of chronic hepatitis C virus (HCV) achieves sustained virological response (SVR) in the majority of patients. Even after initial virological failure, re-treatment with the combination of sofosbuvir+velpatasvir+voxilaprevir (SOF/VEL/VOX) has been established as an effective second line regimen. However, some patients fail to achieve SVR after a second antiviral course with SOF/VEL/VOX. These patients are considered difficult-to-cure. Currently, the optimal regimen for antiviral re-re-treamtent is a matter of debate and European and American guidelines suggest the combination of SOF+glecaprevir/pibrentasvir (G/P) + Ribavirin as a salvage regimen. However, there is only little evidence to support this. In this study, data of two patients with genotype 3 chronic HCV infection, liver cirrhosis and virological failure after re-treatment with SOF/VEL/VOX that successfully achieved SVR with the combination of SOF+G/P ± RBV. Importantly, one patient had Child B cirrhosis to the time of treatment initiation. No adverse events were reported. Thus, our data support the use of SOF + G/P + RBV as a salvage regimen after re-treatment failure with SOF/VEL/VOX.