Previously treated with an HCV regimen containing an NS5A inhibitor Chronic hepatitis C genotype 5

Chronic hepatitis C virus genotype 5 and treatment with NS5A inhibitors

Chronic hepatitis C virus (HCV) genotype 5 is an aggressive form of HCV infection which is difficult to treat. Over the past decade, new antiviral drugs have been developed and used to treat HCV, including the entry inhibitor sofosbuvir and the NS5A inhibitor ledipasvir, which are typically used together with an NS3 protease inhibitor. This so-called regimen is known to produce high sustained virologic responses in people infected with HCV genotype 5.

NS5A inhibitors are small molecules which are capable of penetrating the HCV-infected liver cells and preventing the virus from replicating. This leads to decreased HCV levels and improved liver health. In addition, NS5A inhibitors are thought to increase the effectiveness of other drugs used to treat HCV, which is particularly important in patients with genotype 5.

The addition of NS5A inhibitors to a regimen for treating HCV genotype 5 has been found to lead to improved outcomes in both treatment-naive and previously-treated patients. In a study of 44 previously-treated HCV genotype 5 patients, a regimen containing sofosbuvir 400mg plus ledipasvir 90mg was found to be effective, with an overall sustained virologic response rate of 95%. Another study of 53 genotype 5 patients found 96% short-term sustained virologic response rates were achieved with a sofosbuvir/ledipasvir regimen.

Advantages of Using NS5A Inhibitors to Treat Genotype 5

• NS5A inhibitors penetrate the liver cells more effectively than protease inhibitors, making them more effective against genotype 5.
• NS5A inhibitors provide higher virologic suppression in cirrhotic patients than protease inhibitor-based regimens.
• Studies have shown that a regimen of sofosbuvir and ledipasvir has high sustained virologic response rates in both treatment-naive and previously treated patients with genotype 5.

Conclusion

NS5A inhibitors are a safe and effective treatment option for patients with HCV genotype 5. A regimen containing the NS5A inhibitor ledipasvir appears to produce higher sustained virologic response rates than regimens containing other drugs and is recommended for both treatment-naive and previously-treated patients with this genotype.