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The use of the new pangenotypic direct-acting antivirals in special populations.

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eMediNexus    19 February 2018

A new study published in Liver International disclosed that the notion of "special populations" – patients with chronic kidney disease (CKD), hepatitis C virus (HCV)/human immunodeficiency virus (HIV) co-infection, HCV/HBV co-infection and an unsuccessful previous DAA regimen, is no longer pertinent with pangenotypic direct-acting antivirals (DAAs) combinations. This study included scientific evidence on the treatment of "special populations", specifically, from the RUBY 1-2 trials, EXPEDITION 2-4 study, C-WORTHY trial, ASTRAL 5, POLARIS 1-4 studies, MAGELLAN 1 and REVENGE study. It was found that CKD and HCV/HIV co-infection are not predictors of a non-viral response. Meanwhile, glecaprevir/pibentrasvir combination seemed to be the first-line therapy for CKD patients while the sofosbuvir/vlpatasvir/voxaliprevir combination is the first-line option for DAAs failures. It was stated that both treatments are effective in patients with HIV-or HBV-HCV co-infection and should be chosen according to the potential drug-drug interaction profile. In inference, it was stated that international guidelines recommend treating all infected patients and future objective should focus on improving the limitations for screening and access to care in HCV infection.

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