Effectiveness of direct-acting antiviral therapy in patients with a HCV/HIV coinfection. A multicenter cohort study

Rial-Crestelo, David; Rodríguez-Cola, Miguel; González-Gasca, Francisco Javier; Geijo-Martínez, Paloma; Belinchón-Moya, Olga; Martı́nez-Alfaro, Elisa; Mateos-Rodríguez, F.; Barberá, José Ramón; Yzusqui, Miguel; Casallo, Sonia; García, María Luisa Gutiérrez; Espinosa-Gimeno, Alfredo; Torralba, Miguel

doi:10.17235/reed.2017.5210/2017

Cited by 5 publications

(5 citation statements)

References 19 publications

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“…In this international cohort of PLWH coinfected with HCV treated with DAAs, we observed high rates of HCV cure (93% overall, including 91.4% of PLWH with cirrhosis) similar to other real-world HCV-coinfected cohorts [18–20] and despite the high prevalence of ongoing barriers to care in our cohort. Among the 7% of patients who failed therapy, patient-related factors prompting premature DAA discontinuation predominated over DAA virologic failure.…”

Section: Discussionsupporting

confidence: 85%

Predictors of Hepatitis C Treatment Failure After Using Direct-Acting Antivirals in People Living With Human Immunodeficiency Virus

Cachay

Mena

Morano

et al. 2019

Open Forum Infectious Diseases

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Background Little is known about the influence of ongoing barriers to care in the persistence of hepatitis C virus (HCV) viremia after treatment with direct-acting antivirals (DAAs) among people living with human immunodeficiency virus (PLWH). Methods We conducted a retrospective cohort analysis of PLWH treated through the standard of care in 3 Western countries, to investigate the predictors of HCV treatment failure (clinical or virologic), defined as having a detectable serum HCV ribonucleic acid within 12 weeks after DAA discontinuation. In addition to HCV and liver-related predictors, we collected data on ongoing illicit drug use, alcohol abuse, mental illness, and unstable housing. Logistic regression analyses were used to identify predictors of HCV treatment failure. Results Between January 2014 and December 2017, 784 PLWH were treated with DAA, 7% (n = 55) of whom failed HCV therapy: 50.9% (n = 28) had a clinical failure (discontinued DAA therapy prematurely, died, or were lost to follow-up), 47.3% (n = 26) had an HCV virologic failure, and 1 (1.8%) was reinfected with HCV. Ongoing drug use (odds ratio [OR] = 2.60) and mental illness (OR = 2.85) were independent predictors of any HCV treatment failure. Having both present explained 20% of the risk of any HCV treatment failure due to their interaction (OR = 7.47; P < .0001). Predictors of HCV virologic failure were ongoing illicit drug use (OR = 2.75) and advanced liver fibrosis (OR = 2.29). Conclusions People living with human immunodeficiency virus with ongoing illicit drug use, mental illness, and advanced liver fibrosis might benefit from enhanced DAA treatment strategies to reduce the risk of HCV treatment failure.

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Section: Discussionsupporting

confidence: 85%

Predictors of Hepatitis C Treatment Failure After Using Direct-Acting Antivirals in People Living With Human Immunodeficiency Virus

Cachay

Mena

Morano

et al. 2019

Open Forum Infectious Diseases

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“…The results of this study showed that a sustained viral response was achieved in greater than 95% of treated patients [ 7 ], and this result is consistent with our data. Toxicity and therapeutic abandonment were exceptional [ 20 ]. The COVID-19 pandemic is one of the main factors that explains the decrease in the number of cases treated in recent years.…”

Section: Discussionmentioning

confidence: 99%

Real-life experience of hepatitis C treatment in a Spanish prison

Tejera-Pérez¹,

Iglesias-Gómez²,

Oliva-Oliva³

et al. 2022

Rev Esp Quimioter

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Background. Hepatitis C virus (HCV) infection is a major public health problem that causes multiple comorbidities. People in prisons who inject intravenous drugs are at increased risk of HCV infection, and HCV infection is 15-fold more prevalent among prisoners compared with the community. The objective of this study was to analyse the clinical and epidemiological characteristics of residents of a Spanish prison with HCV infection who received antiviral treatment. Material and methods. An observational, descriptive and retrospective study was performed. All patients with HCV infection diagnosed or followed up in an Infectious Diseases attached to a penitentiary were included in this study. Results. Of 81 patients analysed, sixty-nine (83.1%) patients were male. The mean age was 50.1 (SD8.8) years, and 70% of the inmates had a history of injection drug use. Coinfection with HIV was detected in 30%. In up to 25% of the sample, there were data on chronic liver disease in the degree of liver cirrhosis. The diagnosis of HCV infection had been made more than 15 years earlier in 28% of those studied. Decompensations from liver disease, hepatocellular carcinoma, or hospital admissions were exceptional. Most of the inmates with HCV accepted treatment, and approximately 94% of the patients who completed treatment achieved a sustained virological response without interactions or complications of interest. Conclusions. The availability of direct-acting antivirals and their exceptional side effects constitute an opportunity to reduce the burden of HCV infection in Spain, particularly in these high-risk populations.

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“…The most prevalent HCV genotypes associated with parenteral drug use in Europe are GT1a and GT3a. GT1a dominates in Spain among people who inject drugs 53 , 54 and HIV/HCV coinfected 7 , 55 . According to a recent observational analysis, from 1988 to 2015 in North-Eastern Spain there has been an increase in the prevalence of GT1a, GT3 and GT4 associated with male gender and parental use of drugs, currently the most prevalent route of infection, and a concomitant decline of GT1b, associated with transfusion or parenteral/nosocomial transmission 56 .…”

Section: Discussionmentioning

confidence: 99%

Epidemic history and baseline resistance to NS5A-specific direct acting drugs of hepatitis C virus in Spain

Palladino

Ezeonwumelu

Maté-Cano

et al. 2020

Sci Rep

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Hepatitis C virus (HCV) infection remains a global health problem. Previously, the prevalence of NS5A resistance-associated substitutions (RASs) to elbasvir, a new direct-acting antiviral (DAA) against the NS5A viral protein was assessed by our group before its introduction into clinical use in Spain. However, the origin, epidemic history, transmission dynamics, diversity and baseline RASs to NS5A direct-acting agents of HCV-GT1a in Spain remain unknown. A nationwide cross-sectional survey of individuals chronically-infected with HCV-G1a and DAAs-naïve was performed. HCV population sequencing, phylogenetic analysis and Bayesian methods were used. GT1a clade II was more prevalent than clade I (82.3% vs. 17.7%; P < 0.001) and older (estimated origin in 1912 vs. 1952). Clade II epidemic is currently declining whereas clade I epidemic has reached equilibrium. A total of 58 single RASs were identified, which account for the moderate level (10%) of baseline resistance observed. When considering the regional data, marked differences were observed, with thirteen regions showing an intermediate level (5-15%) and one a high level (20%) of resistance. Current HCV-GT1a epidemic in Spain is driven by clade I which seem to have different dissemination routes relative to clade II. A moderate level of baseline RASs to NS5A-DAAs with marked differences among regions was observed. Close surveillance of response to treatment with DAAs will be important. Hepatitis C virus (HCV) infection is a global health problem with latest data estimates 71.1 million viraemic chronic infections (1.1% of world population) 1. HCV displays high genetic heterogeneity and is classified into eight major genotypes (1-8) 2 and 86 subtypes 3. Worldwide there are significant differences in epidemic history among the HCV genotypes (GT) which may differ in response to treatment, with GT1 being the most represented 4. Among HCV-infected patients also coinfected with human immunodeficiency virus (HIV) subtype 1a (GT1a) prevails 5-7. Despite the high rates of cure with the new direct-acting antivirals (DAAs), the presence of NS5A resistance-associated substitutions (RASs) may compromise the efficacy of NS5A inhibitors. Recently, Zeuzem and colleagues (2017) observed that pretreatment ledipasvir-specific RASs (identified in 8-16% of patients) may compromise treatment outcome particularly in treatment-experienced patients with GT1a, as they found a sustained virological response (SVR) rate of only 76% in patients with pretreatment RASs 8. The seroprevalence of HCV infection in Spain is 1.1% 9 and hepatitis C leads the list of infectious disease related mortality 10. GT1 accounts for 67% of all HCV infections and GT1a causes 40% of all GT1 infections 11. Until October 2018 117,452 patients had access to DAAs and 95.5% had SVR in the frame of the national plan of universal access to treatment 12 while 1.1% of those cured are reinfected 7 .

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Effectiveness of direct-acting antiviral therapy in patients with a HCV/HIV coinfection. A multicenter cohort study

Abstract: HCV treatment in coinfected patients is highly successful in terms of SVR rate in the real-life setting and toxicity is exceptional. We identified no specific predictors of an unfavorable outcome.

Cited by 5 publications

References 19 publications

Predictors of Hepatitis C Treatment Failure After Using Direct-Acting Antivirals in People Living With Human Immunodeficiency Virus

Predictors of Hepatitis C Treatment Failure After Using Direct-Acting Antivirals in People Living With Human Immunodeficiency Virus

Real-life experience of hepatitis C treatment in a Spanish prison

Epidemic history and baseline resistance to NS5A-specific direct acting drugs of hepatitis C virus in Spain

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