Effectiveness of direct-acting antivirals for hepatitis C virus infection in hepatitis C/HIV coinfected individuals

Abstract

In a hepatitis C virus (HCV)/HIV-positive Brazilian cohort, evaluate the safety and efficacy of HCV DAAs, the frequency of resistance substitutions in the HCV NS5A and NS5B genes and identify predictors of treatment failure. Retrospective multicenter study of HCV/HIV patients treated with sofosbuvir (SOF)-based regimens at 10 reference centers in Brazil. Clinical and virological data were collected. Genetic diversity in the NS5A and NS5B genes was assessed by direct nucleotide sequencing. The primary outcome was sustained virological response (SVR) 12 weeks after DAA completion. Of 643 HCV/HIV patients analyzed, 74.7% were male, median CD4+ T cell count was 617 cells/mm 3 , 90% had an undetectable HIV viral load. HCV genotype 1 was detected in 80.2%, and 60% were taking at least 1 medication other than antiretroviral drugs during their DAA therapy. Cirrhosis was present in 42%. An SOF/daclatasvir (DCV) regimen was used in most patients (98%). The frequency of NS5A polymorphisms associated with clinically relevant resistance to DCV was 2%; no relevant NS5B variants were identified. The SVR12 rate was 92.8% in an intention to treat (ITT) analysis and 96% in a modified ITT (m-ITT) analysis. AE occurred in 1.6% of patients. By multivariate analysis, therapeutic failure was associated, in the m-ITT analysis, with concomitant use of anticonvulsant drugs ( P = .001), age ( P = .04), and female gender ( P = .04). SOF/DCV regimens were associated with a high SVR rate in an HCV/HIV population. The use of concurrent anticonvulsant drugs and DAAs decreases the chances of achieving an SVR.

Pangenotypic and Genotype-Specific Antivirals in the Treatment of HCV Genotype 4 Infected Patients with HCV Monoinfection and HIV/HCV Coinfection

“…Similar efficacy was documented in real-world studies of HCV/HIV coinfection conducted by Machado et [25][26][27][28][29]. In the abovementioned real-world analyses, patients were treated predominantly with genotype-specific regimens, only a few patients received the first available pangenotypic option of SOF ± DCV ± RBV.…”

Hepatitis C virus: A critical approach to who really needs treatment

“…A recent multicenter study of SOF/DCV from Brazil showed an SVR12 rate of 92.8% in an intention-to-treat analysis. There was no comparison with HCV mono-infected patients[ 344 ]. A similar SVR12 of 94% was reported in a retrospective study from the United States.…”

The treatment choices and outcome of hepatocellular carcinoma in hemophilic patients with human immunodeficiency virus/hepatitis C virus (HIV/HCV) coinfection due to contaminated blood products in Japan

“…Only 3 cases in this study had received DAA before the diagnosis of HCC, all of which could achieve SVR. The safety and efficacy of DAA in HIV/HCV coinfection has recently been confirmed, so that DAA might contribute to the improvement of both HCV/ HCC treatment in this population, as has already been shown in Western countries (13,14). As mentioned above, the reason of small number in HCV treatment with DAA in Japan might be the reluctant to adopt it because of the possible insufficient collaboration between the hepatologists and hematologists, and/or HIV physicians.…”