Real-world efficacy of direct acting antiviral therapies in patients with HIV/HCV

Abstract

The advent of direct-acting antiviral (DAA) therapies has dramatically transformed HCV treatment, with most recent trials demonstrating high efficacy rates (>90%) across all genotypes and special populations, including patients with HIV/HCV coinfection. The efficacy rates of HCV treatment are nearly identical between patients with HCV monofection and patients with HIV/HCV coinfection; however, there are limited studies to compare real-world efficacy with efficacy observed in clinical trials. Using a database from HIV clinics across the United States (US), we identified 432 patients with HIV/HCV coinfection who completed DAA therapy from January 1, 2014 to March 31, 2017 and were assessed for efficacy. Efficacy was evaluated as sustained virologic response (SVR) 12 weeks after DAA completion; furthermore, factors associated with achieving SVR12 were identified. In this analysis, we found DAA therapies to be effective, with 94% of the patients achieving SVR12 and 6% experiencing virologic failure. Baseline variables, including older age, HCV viral load <800K IU/ML, FIB-4 score <1.45, absence of depression, diabetes, substance abuse, and use of DAA regimens without ribavirin were significant predictors of achieving SVR12. Patients with fewer comorbidities, better liver health, and lower HCV viral loads at baseline were more likely to achieve treatment success. Our results were consistent with other real-world studies, supporting the use of HCV therapy in HIV/HCV coinfected patients.

Mortality in congenital hemophilia A – a systematic literature review

“…52 Deaths from complications of HCV infection such as end-stage liver disease or HCC exhibited a longer and later peak, 23,35 perhaps because of the time taken to develop and succumb to these complications 53,54 or the development of highly effective antiviral therapies against HCV. 55 Two studies reported higher mortality rates when PwH were coinfected with HIV and HCV. 25,35 HIV/HCV coinfection accelerates the progression of hepatic disease as the individual becomes significantly immunocompromised.…”

Indications and waiting list priority for deceased donor liver transplantation in HIV/HCV co‐infected hemophilic patients in Japan through contaminated blood product

“…Nowadays, interferon‐free direct acting antivirals (DAA) treatment has come to allow successful HCV clearance at a significant rate even in the co‐infected patients. It will be a major challenge for the future to examine whether it is appropriate to increase the rank of MELD score for patients with successful HCV clearance 24 . In conclusion, our study group established DDLT criteria for patients with HIV/HCV co‐infection from blood products and perioperative management, and then promptly included patients eligible for liver transplant to the DD transplantation waiting list and performed DDLT.…”

Hepatitis C virus: Current steps toward elimination in Germany and barriers to reaching the 2030 goal

“…HCV infection is also more common in MSM coinfected with HIV (3%‐39%) compared with those without (0%‐19%) 49 . Although HCV is more prevalent in HIV‐coinfected individuals, DAA therapy demonstrates similarly high efficacy in this population compared with those without HIV coinfection 50 . Drug‐drug interactions (DDIs) are a potential problem when combining HIV and HCV treatment; however, studies have demonstrated effective and well‐tolerated management of DDIs as long as care providers are aware of the risk 51 …”