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Case report
Glecaprevir/pibrentasvir+sofosbuvir: an optimal retreatment strategy in the setting of HCV NS5A resistance
  1. Arshia Alimohammadi1,2,
  2. Brian Conway1 and
  3. Leo Yamamoto1
  1. 1Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada
  2. 2Faculty of Medicine, Univertisy of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Arshia Alimohammadi; aarshia{at}


Some individuals do not achieve a cure of their hepatitis C virus (HCV) infection due to non-adherence or resistance associated substitutions. Salvage options that are optimised for resistance profiles are essential. We report a 56-year-old Caucasian man with fatigue, depression and confusion in the setting of untreated HCV genotype 3a infection. He received ruzasvir and uprifosbuvir for 12 weeks within a clinical trial. The patient relapsed 4 weeks after the end of treatment and at this time resistance testing showed multiple resistances including a NS5A Y93H mutation. Given that this mutation confers resistance to first line salvage options, sofosbuvir and glecaprevir/pibrentasvir was used for 12 weeks and the patient was cured of HCV infection 12 weeks after the end of treatment. This shows that sofosbuvir and glecaprevir/pibrentasvir is a viable, effective option for second line/salvage therapy of HCV infection in the setting of resistance to NS5A inhibitors with the Y93H mutation.

  • hepatitis C
  • liver disease

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  • Contributors All authors conceptualised the manuscript. AA drafted and authored the manuscript with input from the other authors. BC and LY were directly involved in the care of the individual highlighted in the case report and also aided in revision and finalisation of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests BC reports grants, honoraria, travel funding and advisory board positions with AbbVie, Merck & Co, Gilead Sciences and ViiV. AA and LY have no relevant conflicts in the past 12 months.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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