Sofosbuvir-based salvage therapy for HCV infection in cirrhotic patients with DAA failure and multidrug resistance

Despite very high efficacies of direct-acting antivirals (DAAs) reported in clinical trials, treatment failure in real-life practice can occur in 5-10% of cases and is mostly associated with emergence of resistance-associated substitutions (RASs). Little is known about the efficacy of retreatment in these patients, especially in those with decompensated cirrhosis, and only a few retreatment studies have been performed so far. Here we present case reports of successful sofosbuvir-based treatment in patients with advanced class B cirrhosis with prior pegylated interferon/ribavirin and all-oral DAA failure with multiclass drug resistance. HCV resistance testing at failure was performed to guide the choice of salvage therapy.