Efficacy of Velpatasvir Sofosbovir alone Versus in Combination with Ribavarin in Cirrhotic Patients with Hepatitis C

Background: Chronic Hepatitis C (HCV) infection is a major cause of liver cirrhosis and its complications. Direct-acting antivirals (DAAs) such as sofosbuvir and velpatasvir have shown high efficacy in treating HCV, but the additional role of ribavirin in combination therapy remains uncertain, particularly in cirrhotic patients. Objective: This study compares the efficacy and safety of sofosbuvir/velpatasvir alone versus in combination with ribavirin in cirrhotic patients with HCV. Methods: This randomized controlled trial was conducted at the Department of Medicine, CMH Kharian. A total of 120 patients with chronic HCV-related cirrhosis (Child-Pugh B or C) were enrolled and randomly assigned to two treatment groups: Group A (sofosbuvir/velpatasvir) and Group B (sofosbuvir/velpatasvir/ribavirin). Both groups received treatment for 12 weeks, and patients were followed up for 12 weeks post-treatment. Results: SVR12 was achieved in 89% of patients in Group A and 92% of patients in Group B. No significant difference was found between the two groups (p = 0.68). Treatment failure occurred in 5% of Group A and 6.7% of Group B patients, while relapse rates were 3.3% and 5%, respectively. The incidence of adverse events was higher in Group B (40%) compared to Group A (28.3%), with the most common side effects being nausea, headache, and fatigue. Severe adverse events, including treatment discontinuation, were reported in 3.3% of patients in Group B but were absent in Group A. Conclusion: Sofosbuvir/velpatasvir alone is as effective as the combination of sofosbuvir/velpatasvir and ribavirin in achieving SVR12 in cirrhotic patients with HCV. The addition of ribavirin did not significantly improve efficacy but was associated with a higher incidence of adverse events.