| Abstract [eng] |
Hepatitis C virus infection is a global public health concern. If left untreated, chronic hepatitis C can progress gradually to cirrhosis, chronic liver failure and hepatocellular carcinoma. Treatment with new second-generation direct-acting antivirals for infection with any genotype of hepatitis C virus results in a sustained viral response rate of more than 95%. However, the treatment of certain patient groups remains challenging. The reasons for the lack of virological response with direct-acting antivirals are varied and include treatment regimen selection and adherence, drug-drug interactions, and patient- and virus-specific factors. However, the main cause of treatment failure is resistance mutations. Resistant strains are detected before the start of treatment or develop during treatment. Treatment with voxilaprevir/velpatasvir/sofosbuvir (glecaprevir/pibrentasvir + sofosbuvir) ± ribavirin for 12 weeks is currently the standard treatment for patients in whom previous combinations of direct-acting antivirals have failed. If this regimen is not available, treatment with first-generation direct-acting antivirals is available, but their efficacy is lower. In such cases, it is useful to investigate resistance mutations to optimize re-treatment. To achieve elimination of hepatitis C virus infection, it is also necessary to overcome other remaining barriers: to ensure access to treatment for all patients and to promote prevention of infection. In this work are presented four clinical cases of patients with chronic hepatitis C with treatment failures, and a discussion of possible causes and solutions. |
