ABSTRACT:
To assess the sustained virologic response (SVR12) and safety profile of 12‐week coblopasvir/sofosbuvir (COB/SOF) therapy in hepatitis C virus (HCV)‐infected patients across genotypes in Northwest China. This prospective cohort study (2023–2024) enrolled HCV patients from 12 clinical centers in Northwest China, adhering to the China Hepatitis C Prevention Guidelines (2022). Participants received daily oral coblopasvir (60 mg) and sofosbuvir (400 mg) for 12 weeks. Key endpoints included HCV RNA quantification, genotype distribution, liver/kidney biomarkers, ultrasound findings, and liver stiffness measurements at baseline, end‐of‐treatment (EOT), and 12 weeks post‐treatment (SVR12). Cirrhosis was defined by ultrasound and transient elastography (> 14.6 kPa). Of 209 initiators, 170 completed treatment (median age 52.5; 57.1% female), including 21 cirrhotic patients. Genotype distribution showed predominance of 1b (38.2%), 2a (31.2%), and 3a (12.4%), with rare 6a (0.6%) and untypable (2.4%). The EOT virologic clearance rate reached 98.8% (168/170), with SVR12 of 99.4% (128/129). Significant improvements occurred in liver biochemical indicators: ALT (
p
< 0.001), AST (
p
< 0.001), GGT (
p
< 0.001), TBil (
p
= 0.04 at SVR12). RBC increased (
p
= 0.04 at EOT;
p
= 0.00358 at SVR12). No renal impairment was observed (Cr, UA, UREA
p
> 0.05). The regimen demonstrated excellent tolerability with no severe adverse events. The COB/SOF combination achieved high SVR12 rates (> 99%) across diverse HCV genotypes in Northwest China, including cirrhotic patients, with concurrent liver function recovery and stable renal parameters. These real‐world data support its first‐line application in resource‐limited regions.