harbor many region-specific HCV subtypes. Nevertheless, direct-acting antiviral (DAA) trials have almost exclusively been conducted in high-income countries, where mainly epidemically spread HCV subtypes are present. Recently, several studies have demonstrated suboptimal DAA efficacy for certain nonepidemic subtypes, which could hamper global HCV elimination. Therefore, we
aimed to evaluate DAA efficacy in patients treated for a nonepidemic HCV genotype infection in the Netherlands.
Methods. We performed a nationwide retrospective study including patients treated with interferon-free DAAs for an HCV
genotype other than 1a/1b/2a/2b/3a/4a/4d. The genotype was determined by NS5B region phylogenetic analysis. The primary end
point was SVR-12. If stored samples were available, NS5A and NS5B sequences were obtained for resistance-associated substitutions
Results. We included 160 patients, mainly infected with nonepidemic genotype 2 (41%) and 4 (31%) subtypes. Most patients
were from Africa (45%) or South America (24%); 51 (32%) were cirrhotic. SVR-12 was achieved in 92% (140/152) of patients with
available SVR-12 data. Only 73% (8/11) genotype 3–infected patients achieved SVR-12, the majority being genotype 3b patients with
63% (5/8) SVR. Regardless of SVR, all genotype 3b patients had 30K and 31M RAS.
Conclusions. The DAA efficacy we observed in most nonepidemic genotypes in the Netherlands seems reassuring. However,
the low SVR-12 rate in subtype 3b infections is alarming, especially as it is common in several HCV-endemic countries. Alongside
earlier results, our results indicate that a remaining challenge for global HCV elimination is confirming and monitoring DAA efficacy in nonepidemic genotypes.