High efficacy of interferon‐free therapy for acute hepatitis C in HIV‐positive patients

Abstract

Background The treatment of acute hepatitis C (AHC) with direct-acting antiviral agents (DAAs) is considered a cornerstone of hepatitis C virus (HCV) elimination strategies, especially in human immunodeficiency virus (HIV)-infected individuals at high risk of onward transmission. Objective Optimal treatment regimens and duration for AHC in HIV-coinfected patients remain to be established. Thus, we aimed to evaluate the efficacy and safety of DAA treatment regimens in the setting of AHC. Methods All HIV-positive patients with a diagnosis of AHC according to the European AIDS Treatment Network (NEAT) consensus attending our clinic after 2014 were included. DAA treatment regimens and duration were based on current recommendations for chronic hepatitis C (CHC) at treatment initiation. Results Thirty-eight HIV/AHC patients (median age 42.0 years), mostly men who have sex with men (92%), were started on interferon-free regimens. HCV-genotype (GT) was predominately GT-1a (65%). The following DAA regimens were prescribed: ombitasvir/paritaprevir/ritonavir/dasabuvir (42%; 16/38), glecaprevir/pibrentasvir (29%; 11/38), sofosbuvir/ledipasvir (13%; 5/38), ombitasvir/paritaprevir/ritonavir (5%; 2/38), grazoprevir/elbasvir (5%; 2/38) and sofosbuvir/velpatasvir (5%; 2/38). All HIV/AHC patients achieved sustained virologic response 12 weeks after end of treatment (SVR12) (100%; 38/38). DAA-related adverse events were rare. Conclusion Interferon-free DAA regimens (including 34% pan-genotypic regimens) yielded 100% SVR12 in HIV/AHC individuals if treatment durations similar to CHC are applied.

Recent outbreaks of severe hepatitis A virus infections in Vienna

“…Transmission usually occurs via the fecal-oral route as per contaminated food or water or person-to-person contact or smear transmission. While effective antiviral therapies are available for other types of viral infections, treatment options for acute HAV infection are limited to symptomatic measures [5,6]. The HAV belongs to the family of Picornaviridae of the genus Hepatovirus and is a nonenveloped single-stranded RNA virus [7].…”

Efficacy and Safety of Glecaprevir/Pibrentasvir for Chronic Hepatitis C Patients: A Systematic Review and Meta-analysis

“…2 In patients with acute HCV and HIV, treatment with glecaprevir/pibrentasvir according to current recommendations (2019) for chronic HCV achieved SVR12 rates of 100%. 41 Drug-drug interactions between glecaprevir/pibrentasvir and antiretrovirals used to treat HIV (integrase inhibitors, nonnucleoside reverse transcriptase, inhibitors, nucleoside/ tide analogues, pharmacokinetic enhancers, and protease inhibitors) have been characterized in 7 phase 1 clinical trials. 42 Glecaprevir/pibrentasvir exposure levels were significantly increased by ritonavir-boosted protease (which inhibit CYP3A, P-glycoprotein, and breast cancer resistant protein) inhibitors and significantly decreased by efavirenz (CYP3A4 inducer), as glecaprevir is a substrate of P-glycoprotein, breast cancer resistant protein and OATP1B1/3 and pibrentasvir is a substrate of P-glycoprotein and/or breast cancer resistant protein.…”

“… 2 In patients with acute HCV and HIV, treatment with glecaprevir/pibrentasvir according to current recommendations (2019) for chronic HCV achieved SVR12 rates of 100%. 41 …”

Epidemiological trends in HCV transmission and prevalence in the Viennese HIV+ population

“…Modern DAA‐based HCV therapy results in SVR rates >95% across all HCV genotypes and HIV coinfected patients . While the historic HCV treatment with pegylated interferon (PEGIFN) and ribavirin (RBV) showed only modest SVR rates and was limited by various patient characteristics, the introduction of DAAs now enables curative treatment at a favourable tolerability in HIV/HCV coinfected individuals including HIV+ patients with acute hepatitis C as well as patients with cirrhosis and prior HCV treatment failure …”

“…1,2, 15 While the historic HCV treatment with pegylated interferon (PEGIFN) and ribavirin (RBV) showed only modest SVR rates and was limited by various patient characteristics, [16][17][18][19] the introduction of DAAs now enables curative treatment at a favourable tolerability in HIV/HCV coinfected individuals including HIV+ patients with acute hepatitis C as well as patients with cirrhosis and prior HCV treatment failure. [20][21][22][23][24][25][26][27][28] Yet, the HCV-associated burden of disease remains high in HIV patients and efforts are needed to expand screening and treatment as well as provide education on risk factors for HCV transmission and effective treatment options. 1,11,[29][30][31][32][33][34] The unrestricted access to novel DAA-regimens in Vienna since September 2017 marked an important step towards the World Health Organization (WHO)-goal of HCV elimination by 2030.…”