Assessment of Treatment Options for Patients with Hepatitis C Virus Recombinant Form 2k/1b.

AIM Hepatitis C virus (HCV) intergenotype recombinant form (RF) 2k/1b has been actively circulating in HCV-infected patients, and the Republic of Georgia has one of the highest prevalence of this RF virus so far reported worldwide. The aim of this study was to define the optimal treatment regimen for patients with RF_2k/1b. METHODS We analyzed the data of 2735 patients who initiated treatment in the Medical Center Mrcheveli within Georgia's hepatitis C elimination program from May 2015 through December 2019. The patients were treated with sofosbuvir (SOF)-based regimens. For identification of RF_2k/1b variants, refinement of standard (INNO-LiPA) genotyping results for all patient samples assigned the unspecific HCV genotypes (GT) 2a/2c was performed by sequencing of core and NS5B genes. RESULTS Overall 444 patients, representing 66% of GT2 and 16% of the total samples were RF_2k/1b. Treatment of patients with RF_2k/1b with sofosbuvir/ledipasvir and sofosbuvir/velpatasvir was highly effective and viral cure rates did not differ among genotypes treated with the same regimen: RF_2k/1b - 99% (343/346) in; GT1-99% (876/885); GT2-96% (156/162); GT3-99% (545/552). A separate comparison analysis of sustain virological response (SVR) rate, treated with SOF plus ribavirin (RBV), showed significantly higher SVR (96%) in patients with confirmed GT2 (by sequencing) compared to unspecified GT2 (by INNO-LiPA) (79%) (P < .05). CONCLUSION SOF-based regimens are highly effective for treatment of RF 2k/1b patients, and with availability of new pan-genotypic direct-acting antivirals (DAAs), genotyping to identify RF 2k/1b patients may not be necessary.