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Treatment of hepatitis C with 8 weeks of ledipasvir/sofosbuvir: Highly effective in a predominantly black male patient population

The combination directly acting antiviral regimen of ledipasvir and sofosbuvir (LDV/SOF) produces high rates of hepatitis C cure in both clinical trials and realworld studies.1–3 The phase 3 studies reported comparable efficacy of 8 and 12 weeks of LDV/SOF in treatment naïve patients without cirrhosis.2,3 Subset analyses of the ION3 study reported cure rates following 8 weeks of therapy were optimized in patients with baseline HCV RNA levels of <6 million4 or favourable genetics,5 although independent analyses differed.6 The Food and Drug Administration LDV/SOF label advised prescribers to consider 8 weeks of LDV/SOF therapy in noncirrhotic, treatment naïve patients with HCV RNA <6 000 000 IU/mL.7 Reallife experiences have shown conflicting results following 8 weeks of therapy among Black patients.8-10 Subsequently, current American Association for the Study of Liver Diseases/Infectious Disease Society of America (AASLD/IDSA) HCV treatment guidelines recommend against 8week LDV/SOF treatment durations in Black patients.11 Given the potential cost savings with reduced treatment durations, the VA guidelines continue to allow for 8 weeks of LDV/SOF in those who can be treated for shortened durations without sacrificing effectiveness: treatment naïve, noncirrhotic patients with HCV RNA levels <6 000 000 IU/mL.12 Here, we report our experience with 8week LDV/SOF therapy among predominantly Black Veterans treated by the VA Maryland Healthcare System (VAMHCS).