SVR achievement in triple-therapy-treated hepatitis C-induced cirrhosis: A dual center retrospective cohort study

Background and Objective:
Multiple prospective and retrospective cohort studies from Western countries have reported conflicting results regarding the efficacy of direct-acting antivirals (DAAs) in achieving sustained virologic response (SVR) among patients with hepatitis C virus (HCV) infection. However, there is limited evidence from South Asia, and almost no data evaluating the effectiveness of triple therapy with ribavirin, sofosbuvir, and daclatasvir in cirrhotic HCV-infected patients from Pakistan. Understanding the real-world effectiveness of this regimen is crucial for improving patient outcomes in resource-limited settings. This study aimed to assess treatment outcomes and identify factors associated with SVR in this population.

Methods:
We conducted a retrospective cohort study of 359 HCV-infected patients treated with triple therapy at two tertiary care hospitals in Pakistan between February 2018 and June 2019. Of these, 187 (53%) were cirrhotic and 172 (47%) non-cirrhotic. Follow-up was incomplete for 158 (44.1%) patients due to death (n = 24, 6.68%), non-response to contact (n = 43, 9.63%), or withdrawal/refusal (n = 91, 25.34%). The final analysis included 201 (55.9%) patients, of whom 87 (43.2%) were cirrhotic, classified using the Liver Stiffness Index. Patients were stratified into SVR and non-SVR groups for comparison.

Results:
Among 201 patients completing follow-up, mean age was 50.6 ± 10.65 years. SVR was achieved in 81 cirrhotic patients (94.2%), while 5 (5.8%) failed therapy. SVR achievement was significantly associated with lower platelet count, elevated total bilirubin, and reduced albumin (p < 0.05). Other demographic and disease-related factors were not statistically significant.

Conclusion:
Triple therapy with ribavirin, sofosbuvir, and daclatasvir demonstrated a high SVR rate (>94%) in Pakistani cirrhotic patients, highlighting its effectiveness in this population. These findings support its continued use as a valuable therapeutic option and provide real-world evidence to guide clinical decision-making and policy development in similar resource-limited settings.