Real-World Effectiveness of Direct-Acting Antiviral Regimens against Hepatitis C Virus (HCV) Genotype 3 Infection: A Systematic Review and Meta-Analysis

Patients with hepatitis C virus (HCV) genotype 3 (GT3) infection are resistant to direct-acting antiviral (DAA) treatments. This study aimed to analyze the effectiveness of sofosbuvir (SOF)+daclatasvir (DCV) ± ribavirin (RBV); SOF+velpatasvir (VEL)±RBV; SOF+VEL+voxilaprevir (VOX); and glecaprevir (GLE)+pibrentasvir (PIB) in the treatment of HCV GT3-infected patients in real-world studies. Articles were identified by searching the PubMed, EMBASE, and Cochrane Library databases from January 1, 2016 to September 10, 2019. The meta-analysis was conducted to determine the sustained virologic response (SVR) rate, using R 3.6.2 software. Thirty-four studies, conducted on a total of 7328 patients from 22 countries, met the inclusion criteria. The pooled SVR rate after 12/24 weeks of treatment was 92.07% (95% CI: 90.39–93.61%) for the evaluated regimens. Also, the SVR rate was 91.17% (95% CI: 89.23–92.94%) in patients treated with SOF+DCV±RBV; 95.08% (95% CI: 90.88–98.13%) in patients treated with SOF+VEL±RBV; 84.97% (95% CI: 73.32–93.91%) in patients treated with SOF+VEL+VOX; and 98.54% (95% CI: 96.40–99.82%) in patients treated with GLE+PIB. The pooled SVR rate of the four regimens was 95.24% (95% CI: 93.50–96.75%) in non-cirrhotic patients and 89.39% (95% CI: 86.07–92.33%) in cirrhotic patients. The pooled SVR rate was 94.41% (95% CI: 92.02–96.42%) in treatment-naive patients and 87.98% (95% CI: 84.31–91.25%) in treatment-experienced patients. The SVR rate of GLE+PIB was higher than other regimens. SOF+VEL+VOX can be used as a treatment regimen following DAA treatment failure.