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Successful Treatment of Hepatitis C, Genotype 3, Treatment Failure (Sofosbuvir/Daclatasvir) with Sofosbuvir/Velpatasvir in Decompensated Cirrhosis Complicated by Renal Insufficiency

Clinical trials and real word data have proven that chronic hepatitis C (HCV) can be eradicated (sustained virological response SVR or ‘cure’) in the majority of patients by direct acting antivirals (DAAs) . There are, however, groups of patients in whom HCV treatment outcomes with direct acting antivirals (DAAs) are suboptimal (genotype (GT) 3 patients, decompensated cirrhosis, renal failure) or have not been studied in large cohorts (patients with relapse to a previous DAAs treatment (failure)). This case outlines the successful eradication of GT-3 hepatitis C (HCV) in a patient with decompensated cirrhosis and renal failure secondary to diabetes after DAA failure, using a 24-week course of sofosbuvir, velpatasvir and ribavirin. The achievement of SVR in this patient resulted in significant improvement in hepatic function . Patients with decompensated cirrhosis and GT-3 disease remain a difficult to treat population, specially after first-line DAA failure and with chronic Kidney disease (CKD). The safety and efficacy of sofosbuvir, velpatasvir and ribavirin in this cohort require further study. with minimal side effects. There are, however, groups of patients in whom HCV treatment outcomes with DAAs are suboptimal (genotype (GT) three patients, decompensated cirrhosis, renal failure) or patients with previous treatment DAAs failure and resistance [1]. Virologic failure to DAA-based therapies is associated with the selection or resistant viral isolates and retreatment with the same regimen has limited efficacy. Few data are available on yhe virological and clinical outcomes of advance liver disease patients with CKD, unfavorable genotype retreated after first line DAA failure.