Data on direct-acting
antiviral agent (DAA) treatment for mixed genotype hepatitis C virus (HCV)
infection are scant. This study examined the effectiveness of
glecaprevir/pibrentasvir (GLE/PIB) and
ledipasvir/sofosbuvir (LDV/SOF) for mixed HCV genotype
infection in a real-world setting in Taiwan. We analysed the data from all patients with mixed HCV genotype
infections treated with GLE/PIB or LDV/SOF from 2017 to 2019 in three Chang Gung Memorial Hospitals in Taiwan. The primary treatment outcome was sustained virologic response 12 weeks
after treatment cessation (SVR12). Adverse events (AEs) were also evaluated. A total of 5190 HCV patients received DAA treatment during this time period. Among them, 116 patients (2.2%) had
mixed infections of any 2 or 3 genotypes of 1a, 1b, 2, 3 and 6. Fifty-four patients received GLE/PIB and 62 received LDV/SOF. SVR12 rates for LDV/SOF vs GLE/PIB
therapy were 96.6% (56/58) vs 100% (51/51) by the per-protocol analysis and 90.3% (56/62) vs 94.4% (51/54) by the evaluable population analysis. Two patients with 1b + 6 and 1b + 2 genotype
infections in the LDV/SOF group had relapse. Evaluating the GLE/PIB vs LDV/SOF groups for the most common AEs revealed
pruritus (16.7% vs 4.8%), abdominal discomfort (5.6% vs 8%) and
fatigue (5.6% vs 4.8%). One patient with AE-related treatment discontinuation presented with liver decompensation after 4-week GLE/PIB
therapy. DAA-related significant laboratory abnormalities occurred in two patients with >3× elevated
bilirubin level in the GLE/PIB group. GLE/PIB and LDV/SOF are well tolerated and achieve high SVR12 rates for patients with mixed HCV genotype
infection.