Direct-Acting Antiviral Regimens and HCV Treatment Failure and Re-Treatment in Sub-Saharan Africa

Data from sub-Saharan Africa on direct-acting antivirals and HCV treatment outcomes are scarce because of inadequate health-care delivery and low research capacity. The SHARED trial, published in 2019, evaluated treatment of chronic HCV infection in treatment-naive patients in Rwanda with ledipasvir–sofosbuvir.

In two single-arm follow-up studies (SHARED-3), published in The Lancet Gastroenterology & Hepatology, researchers evaluated the safety and efficacy of sofosbuvir–velpatasvir-containing regimens to treat chronic HCV infection in patients in Rwanda: the first study investigated sofosbuvir–velpatasvir in treatment-naive patients, while the second investigated sofosbuvir–velpatasvir–voxilaprevir in patients who previously had treatment failure with one or more courses of direct-acting antiviral drugs. The patients in SHARED-3 were predominantly infected with HCV
genotype 4 non-a/d subtypes, which are endemic to the region and frequently contain resistance associated-substitutions in NS5A.

The two SHARED-3 studies and the accompanying comment can be accessed here:

• Safety and efficacy of sofosbuvir-velpatasvir to treat chronic hepatitis C virus infection in treatment-naive patients in Rwanda (SHARED-3): a single-arm trial
• Safety and efficacy of sofosbuvir–velpatasvir–voxilaprevir for re-treatment of chronic hepatitis C virus infection in patients with previous direct-acting antiviral treatment failure in Rwanda (SHARED-3): a single-arm trial
• Direct-acting antiviral regimens and HCV treatment failure and re-treatment in sub-Saharan Africa