Peritransplant Antiviral Treatment of Human Immunodeficiency Virus/Hepatitis C Virus–Coinfected Patients

Abstract

TO THE EDITOR:The availability of direct-acting antivirals (DAAs) has transformed the treatment scenario in human immunodeficiency virus (HIV)/hepatitis C virus (HCV)coinfected patients with sustained virological response (SVR) results over 90%-95%. In the peritransplant setting, there are few real-world experiences in treating patients with HIV/HCV coinfection.Our aims were to describe the outcomes of antiviral treatment with DAA in HIV/HCV-coinfected patients in terms of efficacy, safety, and drug-drug interactions (DDIs) in the pretransplant (waiting list [WL]) and posttransplant settings and to compare these results to HCV-monoinfected patients. MethodsWe conducted a retrospective and observational case-control study in a single center, Hospital Universitario y Politécnico La Fe (Valencia, Spain), which was approved by the local institutional review board. All HIV/HCV-coinfected patients who initiated HCV antiviral treatment with interferon (IFN)-free regimens from March 2014 to March 2016 either on the WL for liver transplantation (LT) or after LT were included. Each HIV/HCV-coinfected patient was matched with 2 HCV-monoinfected patients by HCV genotype (when possible), fibrosis stage, and treatment regimen, and, in the case of cirrhosis, with Model for End-Stage Liver Disease (MELD) and Child-Pugh scores.Treatment regimen choice was based on drug availability at each time point, as given by compassionate-use programs and progressive drug commercialization.Data were collected per local standard of care and at different time points: baseline (pretreatment), ontreatment (weeks 4, 12, and 24), and after treatment (weeks 4, 12, 24, and 48). Patients were followed up to 2 years since treatment initiation.For the descriptive analysis, quantitative variables are presented as median and/or mean and interquartile ranges (IQRs) or range, while categorical variables are presented as frequencies and percentages. Differences between categorical variables were assessed by chisquare test. Continuous variables were compared using the Student t test. All data were analyzed using STATA, version 12 (Stata Corp., College Station, TX). ResultsNine HIV/HCV-coinfected patients on the WL for LT were included, matched to 18 HCV-monoinfected patients in the control group. A total of 14 HIV/HCVcoinfected LT recipients with HCV recurrence receiving 15 antiviral treatments (1 patient was retreated after relapse) were included, matched to 30 HCVmonoinfected patients in the control group. Baseline features of pretransplant and posttransplant patients are summarized in Table 1. Notably, 11% of patients included (8/45) received a sofosbuvir (SOF) + ribavirin (RBV) regimen, which is not currently the recommended standard of care but was the only available regimen at the moment (see Table 1).