Real World Experience with All-Oral Interferon Free Regimen for the Treatment of Lebanese Patients with Hepatitis C Virus (HCV) Infection

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Objectives: The treatment of hepatitis C has dramatically improved since the introduction of new direct-acting antivirals (DAAs). The aim of this study was to assess the efficacy and safety of all oral DAAs, with or without ribavirin, in the treatment of naive and treatment experienced hepatitis C virus (HCV) Lebanese patients. Methods: This study reviewed all cases approved for hepatitis C treatment with DAAs, according to Lebanese guidelines for treatment of HCV at the Ministry of Public Health from October 2015 to December 2016. Available data on age, gender, genotype (GT) and subtype, fibrosis stage, previous treatment (if present), new DAAs treatment, and sustained virological response at week 12 (SVR12) were collected. Results: During a period of 15 months, a total of 186 patients were treated with DAAs. In total, 57% were male. The mean age of the patients was 54.3 years. Genotype 1 was the most prevalent (45%), followed by genotype four (34%) and genotype three (12%). More than 72% of patients had advanced fibrosis (F3 - F4) before starting DAAs and 42% of patients were treatment experienced. Regarding the different DAAs protocols used, SVR12 was achieved in 93% of cases, while 4% did not achieve SVR. Furthermore, 3% of cases were either lost to follow up or had major adverse events. Sustained virological response at week 12 was 93%, 96%, and 94% in GT1, GT3, and GT4, respectively. In cirrhotic patients, SVR12 was 90%. There was no difference in SVR12 between treatment naive and treatment-experienced patients. Hepatocellular carcinoma developed in five patients during the period of the study. Conclusions: This is the first real world Lebanese data concerning hepatitis C treatment with DAAs. It showed a satisfactory response rate irrespective of previous treatments or the stage of fibrosis.