Feasibility, Tolerance and Efficacy of Interferon-free, Antiviral Treatment With Sofosbuvir + Ribavirin for the Treatment of Genotype 2 and Sofosbuvir/Ledipasvir for the Treatment of Genotype 1 and 4 Hepatitis C Virus-infected Patients in West and Central Africa

Study design Multicenter, phase IIb, non randomized, open-label trial involving 3 groups of HCV-mono infected or HCV-HIV co-infected patients: group G1 (patients infected with HCV genotype 1), group G2 (patients infected with HCV genotype 2), and group G4 (patients infected with HCV genotype 4).

Number of Subjects A sample size of 40 patients per group will allow to demonstrate that the SVR12 is >70% ("expected efficacy" in difficult-to-treat patients, according to SPARE interim results), with the lower bound of the confidence interval being >50% ("unacceptable" efficacy). The overall sample size is 3x40=120 patients.

Participating Countries 3 countries from West Africa (Senegal, Côte d'Ivoire) and Central Africa (Cameroon) Number of Sites 5 clinical sites:

• Côte d'Ivoire: Hepatology Departementat the Yopougon University Teaching Hospital, , Abidjan; and Blood Donors clinic (CMSDS) at the National Blood Bank (CNTS), Abidjan
• Senegal: CRCF (Centre Régional de Recherche et de Formation), and Fann University Teaching Hospital
• Cameroon: Clinique de la Cathédrale

Duration of Recruitment : 6 months

Duration of Treatment : 12 weeks

Duration of follow-up : 36 weeks

Anticipated Start Date / Anticipated End Date: November 2015 - October 2016

Target Population /Demographics : Patients >18 years, living with chronic hepatitis C genotype 1, 2 or 4, in West and Central Africa. In each genotype group approx. 50% of patients will be HCV-HIV co-infected, and 50% of patients will be mono-infected with HCV

This study will enable us to assess the feasibility, tolerance and efficacy of such a strategy in resource-constrained settings with considerable treatment needs.

Inclusion criteria

• Age≥18 years
• Confirmed G1, G2 or G4 HCV infection
• Plasma HCV-RNA ≥1000 IU/mL
• No history of HCV treatment of any kind
• Willingness to use a birth control method (hormonal or intrauterine device for women, condoms for men), starting before HCV treatment initiation and continued until 4months (women) and 7 months (men) after end of treatment.
• Weight ≥40 kg and ≤125 kg

For patients infected with HIV :

• Confirmed HIV-1 infection
• Stable HIV treatment for at least 8 weeks with two NRTIs (tenofovir or abacavir, and lamivudine or emtricitabine) and a third agent (raltegravir, lopinavir/ritonavir, atazanavir/ritonavir, darunavir/ritonavir, efavirenz, nevirapine)
• Current CD4+ lymphocytes count ≥100/mm3
• Current plasma HIV-1 RNA <200 copies/mL

Exclusion criteria

For each patient:

• Cirrhosis classified Child-Pugh B or C
• Co-infection by the Hepatitis B virus
• Pregnant or breastfeeding ongoing
• History of transplantation of organs or tissues
• Progressive Cancer, including hepatocellular carcinoma
• Epilepsy
• Sickle Cell Disease
• A history of myocardial infarction or other severe heart disease
• Excessive consumption of alcohol or drug users, in the absence of substitution by methadone, a stable weaning for more than three months should be required
• Ongoing Participation in another clinical trial
• Contraindications to the Sofosbuvir as defined in the Summary of Product Characteristics
• At least one of the following laboratory abnormalities:

Haemoglobin <10 g / 100 ml (woman) <11 g / 100 ml (man) Platelet count <50,000 / mm3 polymorphonuclear neutrophils rate <750 / mm3 Creatinine clearance <50ml / min

For patients infected with HIV:

• Severe opportunistic infections in the last 6 months
• Poor adherence to antiretroviral treatment history
• Use of antiretroviral drugs other than those permitted in the test