Current all-oral interferon-free regimens offer sustained virological response (SVR) rates above 90% as well as 12-week treatment du
rations for
the majority of patients with chronic hepatitis C virus (HCV), including treatment-naïve and -experienced patients with or without cirrhosis. There are multiple direct-acting antiviral (DAA) combinations that can be selected
to optimize efficacy and safety outcomes. Each of
them can be tailored according
to different parameters including
the use of ribarivin (RBV). For sofosbuvir (SOF)-based combinations, RBV is useful in
the following situations: HCV genotype 1, treatment-experienced, cirrhotic patients, or patients with decompensated cirrhosis, and HCV genotype 3, cirrhotic patients. In
these situations
the addition of RBV allows
to shorten
the treatment
to 12 weeks in
the majority of cases and
therefore decreases
the cost of
the treatment. The need of RBV remains
to be determined in cirrhotic patients with a SOF plus simeprevir regimen. RBV-containing regimens are recommended in all HCV genotype 1a patients who receive
the 3-DAA combination: paritaprevir/r, ombitasvir, dasabuvir. Globally,
the addition of RBV
to the different combinations of DAA increases slightly
the risk of anaemia. However severe anaemia was rare and easily manageable with RBV dose reduction without any impact on SVR.
In practice, because RBV is cheap and well tolerated when combined with interferon-free regimen, it remains a useful tool to fine tune anti-HCV treatment regimens and optimize their results.