The NS5B nucleotide inhibitor sofosbuvir is licensed for the treatment of hepatitis C virus (HCV) infection in combination with other agents. Velpatasvir is an investigational inhibitor of the HCV NS5A protein with antiviral activity against all HCV genotypes.
This study is one of four in the New England Journal of Medicine, which have examined the safety and efficacy of a 12-week course of sofosbuvir and velpatasvir in treating patients with HCV. All the studies reported high rates of sustained virologic response.
According to an editorial, the benefits of curative therapy can be realised only for people who have been tested and know they are infected with HCV. However a high proportion of people remain undiagnosed. The commentators note that progressive steps in HCV care from viral detection to HCV cure are poor in the US and in many other countries; and although currently licensed therapies require that those who are HCV-infected undergo genotyping and disease staging before initiation of treatment, most do not receive this level of care. They suggest that the sofosbuvir–velpatasvir regimen could simplify HCV management by reducing the need for these steps, paving the way for simple “test and cure” strategies appropriate for primary care and other settings, such as addiction-treatment programs. They add that at a population level, the effect of HCV medications will be determined by affordability and equitable access to HCV testing, care, and treatment.