Modeling Predicts Direct-Acting Antiviral Therapy for 5-Weeks May Cure Recent or Chronic Hepatitis C Infection Among People With Undetectable Viral RNA by Day 7.

backgroundIdentifying individuals with hepatitis C virus (HCV) infection who could be cured with a shorter duration of direct-acting antivirals (DAA) therapy would support the effort to reach HCV elimination goals. To date, clinical studies of short-duration DAA therapy based on early (eg, days 2 or 7) HCV RNA levels (eg, < 500 IU/mL) have used arbitrary time points and viral load thresholds, and yielded suboptimal cure rates.

methodsA database of HCV-host parameters was built based on mathematically modeling time to cure in about 300 individuals with recent (duration < 12 months) or chronic infection treated with DAAs. Two hundred thousand parameter combinations of viral-host and treatment parameters were generated, each representing an in silico HCV patient under DAA treatment.

resultsWe assessed response-guided treatment (RGT) strategies based on whether HCV RNA was undetectable on day 7 or day 14 on treatment. The analysis predicted that treatment duration could be shortened to 5 or 7 weeks for people with recent or chronic infection who have undetectable HCV RNA at day 7 or day 14 of treatment, respectively.

conclusionsModeling suggested that most people with recent or chronic HCV treated with DAAs will have undetectable HCV RNA by day 7 or 14 and could have their treatment duration reduced to 5 or 7 weeks. This modeling-independent RGT approach could improve treatment access, facilitate HCV elimination, and reduce cost, particularly in key populations most affected by HCV, such as people who inject drugs.