Efficacy of Sofosbuvir-Velpatasvir-Ribavirin Regimen for Retreatment of Chronic Hepatitis C in Patients with Prior DAA Failure: A Retrospective Study from a National Treatment Center

Introduction : Direct-acting antivirals (DAAs) are highly effective in treating HCV infection, but a small subset of patients may fail to achieve SVR12 and require further intervention. In resource-limited settings where second-line DAAs (such as SOF/VEL/VOX) may be unavailable, optimizing first-line treatments is essential. This study evaluated the efficacy (SVR12) of re-treatment regimen based on first-line DAAs (SOF/VEL) with ribavirin. Method: This retrospective study screened all viremic patients who attended the apex treatment center (ATC) between January 2019 and December 2023 and received DAAs as per the national Viral Hepatitis control program (NVHCP) guidelines. Patients who failed to achieve SVR12 were subsequently retreated with the available first-line regimen (SOF/VEL plus ribavirin). Results: A total of 1,814 viremic patients attended the apex treatment center (ATC). 1262 patients completed therapy. 1198 (94.9%) patients achieved SVR 12 and 64 patients (5.1%) failed to achieve SVR 12. Additionally, 41 patients with DAA failure were referred from treatment center (TC) and model treatment center (MTC) for evaluation. After further exclusions, 36 patients were enrolled, and 30 of them were offered retreatment. The majority of patients were male (64.5%) with a median age of 45 years (IQR; 19-68). Five patients were cirrhotic, while the remainder was non-cirrhotic. Baseline HCV RNA levels before the retreatment regimen was 87,882 IU/ml (IQR; 9,870-484,902). Most patients (96.6%) had genotype 3 HCV infection. Prior to retreatment, 27 patients had received a 12-week regimen of Sofosbuvir and Daclatasvir, while only three had been treated with the Sofosbuvir-Velpatasvir regimen. After retreatment with Sofosbuvir, Velpatasvir, and Ribavirin, 22 patients (73%) achieved SVR12. None of the patients experienced any adverse event. Conclusion: First-line DAAs are highly effective to treat naïve patients. In the absence of second-line options, retreatment with first-line DAAs (SOF/VEL plus ribavirin) is a viable alternative.