The Alaska Native/American Indian experience of hepatitis C treatment with sofosbuvir-based direct-acting antivirals

PLoS One. 2021 Dec 2;16(12):e0260970. doi: 10.1371/journal.pone.0260970. eCollection 2021.


Background: Direct-acting antiviral (DAA) drugs have been effective in the treatment of chronic hepatitis C virus (HCV) infection. Limited data are available on safety, tolerability, and efficacy in American Indian or Alaska Native people. We aim to evaluate the treatment outcomes of sofosbuvir- based regimens for treatment of HCV in a real life setting in Alaska Native/American Indian (AN/AI) people.

Methods: AN/AI patients within the Alaska Tribal Health System with confirmed positive anti-HCV and HCV RNA, who were 18 years of age and older were included in the study. Pretreatment baseline patient characteristics, treatment efficacy based on sustained virologic response (SVR) 12 weeks after treatment completion, and adverse effects were assessed. The following treatments were given according to the American Association for the Study of Liver Diseases/Infectious Disease Society of America (AASLD/IDSA) HCV Guidance: ledipasvir/sofosbuvir, sofosbuvir plus weight-based ribavirin, and sofosbuvir/velpatasvir.

Results: We included 501 patients with a mean age of 54.3 (range 21.3-78.3) in the study. Overall SVR was achieved in 95.2% of patients who received one of the three DAA regimens. For those with cirrhosis, overall SVR was 92.8% and for those with genotype 3 91.1% achieved SVR. The most common symptom experienced during treatment was headache. Joint pain was found to decrease during treatment. One person discontinued sofosbuvir plus ribavirin due to myocardial infarction and one discontinued sofosbuvir/velpatasvir due to urticaria.

Conclusions: In the real-world setting, sofosbuvir-based treatment is safe, effective, and well tolerated in AN/AI patients. Sustained virologic response was high regardless of HCV genotype or cirrhosis status.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Alaska / epidemiology
  • American Indian or Alaska Native / statistics & numerical data*
  • Antiviral Agents / therapeutic use*
  • Benzimidazoles / therapeutic use*
  • Carbamates / therapeutic use*
  • Drug Combinations
  • Female
  • Fluorenes / therapeutic use*
  • Follow-Up Studies
  • Hepacivirus / drug effects*
  • Hepacivirus / isolation & purification
  • Hepatitis C, Chronic / drug therapy*
  • Hepatitis C, Chronic / epidemiology
  • Hepatitis C, Chronic / virology
  • Heterocyclic Compounds, 4 or More Rings / therapeutic use*
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Sofosbuvir / therapeutic use*
  • Sustained Virologic Response


  • Antiviral Agents
  • Benzimidazoles
  • Carbamates
  • Drug Combinations
  • Fluorenes
  • Heterocyclic Compounds, 4 or More Rings
  • ledipasvir, sofosbuvir drug combination
  • sofosbuvir-velpatasvir drug combination
  • Sofosbuvir

Grants and funding

This study was funded in part by Gilead Sciences, Gilead IN-US-334-1329. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.