Interferon-free direct-acting antiviral therapy for acute hepatitis C virus infection in HIV-infected individuals: A literature review

Abstract

Dramatic rises in hepatitis C virus (HCV) coinfection rates in human immunodeficiency virus (HIV)-infected individuals have been observed recently, largely attributable to increasing recreational drug use combined with increased testing for HCV. In the era of direct-acting antiviral (DAA) therapy, treatment of acute HCV infection in HIV-infected individuals with short durations of these drugs may potentially reduce the disease and economic burden associated with HCV infection as well as reducing the likelihood of onward HCV transmission. We performed an extensive literature search of PubMed, Embase and Google Scholar up to 05 September 2017 for clinical trials of acute HCV infection in HIV-infected individuals. In the studies identified, rates of sustained virologic response at 12 weeks post-treatment (SVR12) ranged from 21% with 6 weeks of therapy up to 92% with 12 weeks of therapy with sofosbuvir and ribavirin. Ledipasvir/sofosbuvir for 6 weeks achieved an SVR of 77%. No HIV-related events occurred regardless of whether patients were receiving antiretroviral therapy (ART) and DAAs were well tolerated. Data is currently limited with regards to optimal regimens and durations of therapy, which need to be tailored based on potential interactions with concurrent ART and consideration for the fact that patients with higher baseline HCV RNA levels may require an extended duration of treatment.

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

“…Large, prospective phase-3 studies on pan-genotypic DAA regimens for AHC are now recruiting and the results are expected in the upcoming years. 34 Interestingly, according to baseline TE measurements, only 47% of our patients were classified as F0/F1 fibrosis and 11% presented with values corresponding to F4 fibrosis. However, during the first study period, we had a 'biased' selection of patients with higher liver stiffness (!F2 fibrosis) since reimbursement of DAA therapy was limited to advanced fibrosis with TE values !7.1 kPa being accepted.…”

“…Thus, G/P and SOF/VEL may also be used for HIV/AHC coinfection, and, indeed, the results of our study with SVR12 in 100% (11/11 and 2/2) of patients, respectively, suggest optimal efficacy in this setting. Large, prospective phase‐3 studies on pan‐genotypic DAA regimens for AHC are now recruiting and the results are expected in the upcoming years 34 …”

“…Large, prospective phase-3 studies on pan-genotypic DAA regimens for AHC are now recruiting and the results are expected in the upcoming years. 34…”

Hepatitis C virus treatment response to ledipasvir/sofosbuvir among patients coinfected with HIV and HCV

“…[ 16 – 18 ] However, significant reported drug–drug interactions and restrictions of use in cirrhosis ultimately leads to continued provider variability in regimen choice. [ 17 , 19 , 20 ] This study demonstrates high SVR rate and efficacy of LDV/SOF in Black, HIV/HCV coinfected patients, though further studies are warranted to determine optimal regimens and durations of therapies while balancing patient characteristics, baseline data, and potential interactions with ART.…”