High hepatitis C cure rates among black and nonblack human immunodeficiency virus–infected adults in an urban center

Abstract

Background Hepatitis C virus (HCV) cure rates have been similar in patients with and without HIV co-infection; however, in the ION-4 study, black patients treated with ledipasvir/sofosbuvir were significantly less likely to achieve cure (90%) compared to non-black patients (99%). There are limited real world data on the effectiveness of oral direct acting antivirals (DAAs) in predominantly minority HIV/HCV co-infected populations. Methods We analyzed HCV treatment outcomes among 255 HCV co-infected patients initiating DAAs between February 2014 and March 2016 in an urban clinic in Baltimore, Maryland. To facilitate adherence, patients received standardized HIV nurse/pharmacist support which included nurse visits and telephone calls. Results The median age was 43 years, 88% were black, 73% male, 69% had a history of injection drug use, 45% a history of hazardous alcohol use and 57% a comorbid psychiatric diagnosis. Median CD4 count was 577 (IQR 397–820) cells/mm3; most (97%) were on antiretroviral therapy, had HIV RNA <20 copies/ml (87%) and were infected with HCV genotype 1 (98%). Over 60% had significant fibrosis [FIB4 score 1.45–3.25 (44%) and >3.25 (17%, cirrhosis)] and 30% were HCV treatment experienced. The majority of patients received ledipasvir/sofosbuvir with or without ribavirin (91%) and were treated for 12 weeks. Overall, the sustained virologic response rate was 97% (95% confidence interval [CI] 93–98) and did not vary by race (black, 96% [95% CI 93–98]; Non-black 97%, [95% CI 83–99]), history of injection drug use, alcohol use or psychiatric diagnosis. Conclusion HCV treatment was highly effective among HIV-infected patients who received care within an integrated nurse/pharmacist adherence support program. These results suggest that race and psychosocial comorbidity may not be barriers to HCV elimination.

Rates of sustained virological response 12 weeks after the scheduled end of direct‐acting antiviral (DAA)‐based hepatitis C virus (HCV) therapy from the National German HCV registry: does HIV coinfection impair the response to DAA combination therapy?

“…Nevertheless, in patients with liver cirrhosis, we found no significant difference in HCV cure rate between HCV-monoinfected and HIV/HCV-coinfected individuals. Our results are supported by several studies with various treatment regimens in HIV/HCV-coinfected patients which also reported similar SVR rates in HIV/HCV-coinfected patients including those at more advanced fibrosis stages compared with HCV mono-infected patient groups [10][11][12].…”

“…recently described a relationship between successful HIV RNA suppression to < 20 copies/mL and high SVR rate in coinfected patients. This effect may be driven by a higher adherence to medical treatment in these individuals as well as frequent and continuous relationship with health care professional with and support from a health care professional trained in infectious diseases . These results support our findings that HIV infection is not independently associated with a worse SVR12.…”

HIV/HCV therapy with ledipasvir/sofosbuvir after randomized switch to emtricitabine-tenofovir alafenamide-based single-tablet regimens

“…The overall SVR12 rate is in line with other evaluations of LDV/SOF efficacy in HIV/HCV co-infection, both in the ION-4 clinical trial [10] and in clinical cohort studies [13][14][15][16][17]. However, ION-4 reported a significantly lower SVR12 for black compared with non-black participants (90% and 99%, respectively).…”

“…Combined analysis of the ION-1-3 (HCV mono-infection) and ION-4 (HIV/HCV co-infection) studies in 865 participants found that LDV/SOF efficacy was not affected by the presence of HIV infection [12]. Clinical cohort studies have demonstrated high SVR12 rates for LDV/SOF treatment in HIV/HCV co-infected individuals, consistent with clinical trial findings [13][14][15][16][17].…”

Care2Cure: A randomized controlled trial protocol for evaluating nurse case management to improve the hepatitis C care continuum within HIV primary care

“…Moreover, HCV cure rates may be lower in persons who switch antiretroviral therapy (ART) to accommodate DAAs (Falade-Nwulia et al, 2017)…”