In our study, a hundred patients who were found positive for the hepatitis C virus by Polymerase chain reaction were included. RT-PCR for genetic diversification of the hepatitis C virus was performed using Abbott RealTime HCV Genotype II. Patients were also assessed for their pre and post-treatment viral load as well as other parameters like alanine transaminase, hemoglobin, white cell count, and platelets.
The ages of patients varied between 17 years to 81 years with mean age of 47 years. 45% were males while 55% were females (Figure-I).
After genotyping, the patients were put on three different regimens of antiviral therapy as prescribed by the referring physicians. Sofosbuvir alone, INF in combination with ribavirin, and sofosbuvir and ribavirin were used over the time span of three months. These patients were then assessed for the sustained viral response (SVR) which is defined as the presence of sustained, undetectable HCV RNA levels after at least 12 weeks of completing anti HCV therapy, using a sensitive assay (typically having lower detection limit of 25 IU/mL).
By analyzing the three observed genotypes separately, most of the patients were having genotype 3 (91%) and their response varied with different treatment regimens used. They were also stratified according to the viral load before and after the antiviral therapy.
30 out of 91 patients (33%) with type 3 genotype were treated with sofosbuvir alone. 51 (56%) were treated with sofosbuvir and ribavirin whereas 10 (12%) were treated with INF and ribavirin regimen (Figure-III).
2 out of 30 patients, who were having a viral load of >1,000,000 and treated with Sofosbuvir alone, failed to achieve sustained viral response. This makes the treatment failure rate of Sofosbuvir alone for type 3 genotype of hepatitis C as 6.7% (Figure-IV).
1 out of the 10 patients, who were also having a viral load of >1,000,000 and was treated with a combination of INF and ribavirin, also failed to achieve SVR, making the treatment failure percentage of 10% (Figure-IV). Whereas all the 51 patients (100%) who were treated with sofosbuvir and ribavirin achieved SVR, making it the most effective antiviral therapy in our study (Figure-IV).
All six patients having HCV genotype 1a achieved SVR with different treatment regimens. Out of these six patients, three were given Sofosbuvir alone, two were given combination of INF and ribavirin and one patient received sofosbuvir and ribavirin (Figure-V).
Similarly all three patients having HCV genotype 1b achieved SVR. Two out of these three patients received sofosbuvir and ribavirin whereas one was given combination of INF and ribavirin (Figure-VI).
Pre and post-treatment parameters like alanine transaminase, hemoglobin, white cell count, and platelets were monitored for hepatitis C genotype 3 patients and by using the Paired T-test only alanine transaminase was found to be significantly altered with treatment (Table-I).
Table-I: Effect of treatment on hematological and biochemical parameters in Genotype 3.| Variable | Before Treatment (Mean) | After Treatment (Mean) | P-value |
|---|---|---|---|
| ALT | 49.3 | 45.0 | 0.05 |
| Hb | 12.508 | 12.581 | 0.910 |
| Platelets | 213,074 | 223,386 | 0.975 |
| WBC | 9.736 | 9.778 | 0.95 |
