engleski

Treatment of chronic hepatitis C infection with direct- acting antiviral agents in the southern Croatia

Background and Aims Croatia is one of the 28 European Union member states with an area of 56 594 km2 and inhabited by 4, 171, 000 inhabitants. In the southern part of Croatia, in which this research was carried out, there are 860, 000 inhabitants. Prevalence of hepatitis C virus (HCV) infection in Croatia is low (0.9%). It is estimated that the number of viraemic HCV infection in 2015 was 26 100 of total population of inhabitants in Croatia2. Treatment and cure of HCV with direct-acting antiviral agents (DAA) began in 2014. The treatment with DAA is available to all patients but currently prioritized for patients with F3/F4 fibrosis, extrahepatic manifestations, organ transplantation and HIV or HBV infection. Methods In the period between August 2015 and August 2017, 125 HCV infected patients in three hospitals in the southern Croatia completed therapy with DAAs. There were 78% of men and 22% of female. The majority of enrolled patients (81%) were between 31 and 60 years old, 21 (17% of patients) were over 60 years old and only 3 patients (2%) were younger than 31. Majority of patients, 80/125 (64%) were treatment- experienced (TE). Among them, 65% were relapsers, 29% non-responders, and 4% partial responders on previous treatment protocol. Considering genotype distribution, most of the patients were genotype 1 (69%, among them 1a 42%, 1b 27%), followed by G3a (26%), G2 (1%) and G4 (4%). In all patients fibrosis was determinated by FibroScan® (range 7, 1-70, 6 kPa). Majority of patients (80.8%) had cirrhosis (F4), 12.8% had fibrosis 3 i 6.4% had fibrosis 2. Two patients had decompensated cirrhosis and one had liver transplant. Results Among 125 patients with chronic HCV infection, 56 (44.8%) were treated with ombitasvir/paritaprevir/ritonavir plus dasabuvir +/- ribavirin (RBV) ; 27 (21.6%) were treated with ledipasvir/sofosbuvir +/- RBV ; 20 (16%) were treated with sofosbuvir/velpatasvir +/- RBV ; 15 (12%) were treated with sofosbuvir + RBV and, finally, 7 (5.6%) were treated with elbasvir/grazoprevir +/- RBV. Sustained viral response 12 weeks after completion of therapy (SVR 12) was available for all patients. Only 2 patients did not achieve SVR which gives the SVR rate of 98.4%. One of them had decompensated cirrhosis G1a and was treated with sofosbuvir/velpatasvir and the second had compensated cirrhosis G1a and was treated with ombitasvir/paritaprevir/ritonavir plus dasabuvir. Conclusions Treatment of chronic HCV with DAAs in the southern Croatia is in accordance with other real-life studies. Most of the patients had significantly impaired liver function – fibrosis 3 and 4 (F3/F4) and only 6, 4% had fibrosis 2 (F2). Objective Hopefully, in Croatia in the future DAA therapy will be available not only for pateints with chronic hepatitis C infection with fibrosis F3/F4 but also for the ones with lower stages of fibrosis (F1/F2).

treatment ; chronic hepatitis C infection ; DAA-agents ; the southern Croatia ;

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