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Short duration pan-genotypic therapy with glecaprevir-pibrentasvir for six weeks among people with recent HCV infection.

Authors
  • Martinello, Marianne1, 2, 3
  • Orkin, Chloe4
  • Cooke, Graham5
  • Bhagani, Sanjay6
  • Gane, Edward7
  • Kulasegaram, Ranjababu8
  • Shaw, David9
  • Tu, Elise1
  • Petoumenos, Kathy1
  • Marks, Philippa1
  • Grebely, Jason1
  • Dore, Gregory J1, 2
  • Nelson, Mark10
  • Matthews, Gail V1, 2
  • 1 Kirby Institute, UNSW Sydney, Sydney, Australia. , (Australia)
  • 2 St Vincent's Hospital, Sydney, Australia. , (Australia)
  • 3 Department of Infectious Diseases, Blacktown Mt Druitt Hospital, Sydney, Australia. , (Australia)
  • 4 Queen Mary University of London, London, UK.
  • 5 Department of Infectious Diseases, Imperial College NHS Trust, St Mary's Hospital, London, UK.
  • 6 Department of Infectious Diseases/HIV Medicine, Royal Free Hospital, London, UK.
  • 7 New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand. , (New Zealand)
  • 8 Guy's and St Thomas' Hospital, London, UK.
  • 9 Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, Australia. , (Australia)
  • 10 Chelsea and Westminster Hospital, London, UK.
Type
Published Article
Journal
Hepatology
Publisher
Wiley (John Wiley & Sons)
Publication Date
Oct 24, 2019
Identifiers
DOI: 10.1002/hep.31003
PMID: 31652357
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Among treatment-naïve individuals with chronic HCV infection and without cirrhosis, glecaprevir-pibrentasvir for eight weeks is recommended. The aim of this analysis was to evaluate the efficacy of glecaprevir-pibrentasvir for six weeks in people with acute and recent HCV infection. In this open-label single-arm multicentre international pilot study, adults with recent HCV (duration of infection <12 months) received glecaprevir-pibrentasvir 300mg-120mg daily for six weeks. Primary infection was defined by first positive anti-HCV antibody and/or HCV RNA within six months of enrolment and either acute clinical hepatitis within the past 12 months (symptomatic seroconversion illness or ALT>10xULN) or anti-HCV antibody seroconversion within 18 months. Reinfection was defined as new positive HCV RNA within six months of enrolment and evidence of prior spontaneous or treatment-induced clearance. The primary endpoint was sustained virologic response at 12 weeks post-treatment (SVR12). Thirty men (median age 43 years, 90% men-who-have-sex-with-men) received treatment, of whom 77% (n=23) were HIV-positive, 47% (n=14) had ever injected drugs, and 13% (n=4) had HCV reinfection. The majority had HCV genotype 1 (83%, n=25), followed by genotype 4 (10%, n=3) and genotype 3 (7%, n=2). At baseline, median estimated duration of infection was 29 weeks (range 13, 52) and median HCV RNA was 6.2 log10 IU/mL (range 0.9, 7.7). SVR12 in the intention-to-treat and per-protocol populations was achieved in 90% (27/30) and 96% (27/28), respectively. There was one case of relapse and two cases of non-virological failure (death, n=1; loss to follow up, n=1). No treatment-related serious adverse events were seen. CONCLUSION: Glecaprevir-pibrentasvir for six weeks was highly effective among people with acute and recent HCV infection, supporting further evaluation of shortened duration pan-genotypic therapy in this setting. © 2019 by the American Association for the Study of Liver Diseases.

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