Epidemiological Characteristics Of Hepatitis C Genotype 6patients In Guangxi And Analysis Of Short-term Efficacy Of DAAs Treatment

Objective To analyze the epidemiological characteristics of hepatitis C genotype 6 patients in Guangxi and the short-term efficacy of direct acting antivirals(DAAs)treatment.Methods From December 2012 to December 2020,97 patients with genotype 6 chronic hepatitis C(CHC)who were diagnosed in the Infectious Diseases Department of the First Affiliated Hospital of Guangxi Medical University and met the inclusion criteria were collected from December 2012 to December 2020.Clinical data and retrospective analysis.According to the different treatment options,they were divided into interferon treatment group and non-interferon(DAAs)treatment group.Of the 97 patients,62 patients received antiviral therapy,and 22 patients in the interferon group,of which 18 patients used interferon combined with ribavirin For the treatment of Lin(PR),4patients were treated with PR combined with Sofobuvir(SOF)and 40 patients in the DAAs group.Patients treated with DAAs were treated with the following 4regimens: SOF combined with Velpatasvir(Velpatasvir),VEL)(12 weeks of treatment),SOF combined with Ledipasvir(Ledipasvir,LDV)(12 weeks of treatment),SOF combined with Daclatasvir(DCV)(12 weeks of treatment),SOF combined with ribavirin(Ribavirin,RBV)(24 weeks of treatment).Analyze and process the HCV-RNA viral load,liver function and blood routine of patients 1 week before treatment,4th week of treatment,at the time of discontinuation,12 th week after discontinuation(interferon group needs to be added to the 24 th week after discontinuation),Kidney function and other indicators.Observe and compare the virological response rate,short-term efficacy,and adverse drug events that occurred during the course of treatment of different treatment plans at the 4th week of treatment,when the drug was stopped,and the 12 th week after the drug was stopped.Results 1.Of the 97 patients,69 were males(71.1%)and 28 were females(28.9%).The average age is(41.97±10.12)years old,and most of the infected persons are 30-40 years old.Among them,95 cases(97.9%)were genotype 6a,1case was genotype 6e(1%),and 1 case was genotype 6xa(1%).There were 65 patients enrolled in the group with a clear route of infection,of which 3 patients had dual routes of transmission: 41 cases of intravenous drug use(IVDU),and14 medical-related operations(including surgery,tattoos,and medical beauty-related operations).Among them,9 cases were related to blood transfusion and 4 cases had a history of sexual contact.Among them,1 patient had combined IVDU + medical-related operations,1 case of IVDU + blood transfusion,and 1 case of medical-related operations + history of sexual contact.The main route of transmission for genotype 6 patients is IVDU(P=0.016).2.The overall virological response of patients in the DAAs group: The RVR rate of40 newly-treated patients was 87.5%(35/40),the Epoint rate was 100%(40/40),and the SVR12 rate was 100%(40/40).3.The overall virological response of patients in the interferon group: the rapid virological response(RVR)rate was81.8%(18/22)in the 4th week of treatment,and the virus undetectable(Epoint)rate at the time of drug withdrawal was 86.4%(19 /22),the rate of sustained virological response(SVR12)12 weeks after discontinuation was 81.8%(18/22),and the rate of sustained virological response(SVR24)24 weeks after discontinuation was 81.8%(18/22),One of the patients who used the PR regimen relapsed 3 months after stopping the drug.The SVR rate of DAAs group was significantly higher than that of interferon group.4.The virological response of different genotypes in different DAAs regimens: the RVR,Epoint,and SVR12 rates of SOF/VEL regimens in patients with gene 6a type all reached100%(17/17);with SOF/LDV,SOF/DCV The Epoint and SVR12 rates of the SOF/RBV program are both 100%,and the RVR rates are only 66.7%(4/6),90%(9/10),60%(3/5);patients with gene 6xa and 6e respectively The rates of RVR,Epoint,and SVR12 using SOF/LDV and SOF/DCV solutions all reach100%.Although the RVR rates of patients with different genotypes using different DAAs regimens are very different,they can all get a 100% SVR12 rate.5.Comparison of the short-term efficacy of different DAAs treatment programs:Although the RVR rate of various treatment programs is different,the SVR12 is100%.There was no statistically significant difference between the virological response rates of each treatment plan(P=0.051).6.Comparison of virological response between cirrhosis group and non-cirrhosis group: Among the 40 patients in the DAAs group,7 were with compensated cirrhosis and 33 were with non-cirrhosis.Regardless of whether there is liver cirrhosis,the SVR12 rate can reach 100%.7.Virological response of patients with other diseases: In the DAAs regimen treatment group,there were 2 patients with chronic hepatitis B(CHB)infection and Acquired Immune Deficiency Syndrome(AIDS).)1 case,1 case with Guillain-Barre syndrome(Guillain-Barre syndrome),the rate of RVR,Epoint,and SVR12 reached 100%.8.Liver function changes: Among 40 patients in the DAAs treatment group,24 cases(60%)of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were elevated before treatment,and no liver protection was used during the course of treatment.After the drug and antiviral treatment,the monitoring of ALT and AST decreased to normal(P<0.01).During the period,one patient who used the SOF/VEL regimen had elevated transaminase levels after stopping the drug for a few days due to the epidemic,and the transaminase level dropped to normal after re-antiviral treatment.9.Adverse reactions: A total of 11 cases of adverse events occurred during the course of 22 interferon treatment patients(8 cases of PR regimen,3 cases of PR+SOF regimen),mainly due to blood system damage(Including reduction of neutrophils,hemoglobin,platelets,etc.)Mainly,two of them developed flu-like symptoms,and the above-mentioned adverse reactions improved after the course of treatment.No renal impairment was found.One patient suspended the treatment for a few days due to side effects and resumed treatment.There were 5 cases of adverse events during the treatment of 40 patients in the DAAs group(2 cases of SOF/LDV regimen,2 cases of SOF/DCV regimen,1 case of SOF/RBV regimen),the main manifestations were: abnormal blood system(including anemia),Fatigue,dizziness,headache,etc.,the side effects of the above-mentioned drugs were improved and recovered after stopping the drug.No renal dysfunction occurred in all patients during the course of treatment,and no patients discontinued treatment due to significant drug side effects.Conclusion:1.The main route of infection for patients with genotype 6hepatitis C in Guangxi is intravenous drug addiction,which is more common in men,and the main subtype is type 6a;2.DAAs treatment has a higher virological response rate than interferon treatment,and the SVR12 rate is 100%;3.There is no difference in the SVR12 rate between patients with compensated cirrhosis and non-cirrhosis.