Update in HIV–hepatitis C virus coinfection in the direct acting antiviral era

Meissner, Eric G.

doi:10.1097/mog.0000000000000347

Cited by 23 publications

(20 citation statements)

References 92 publications

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“…[45,46] Possible barriers to a successful HCV response in PLWH include access to medical care, timely diagnosis of HIV/HCV and initiation of DAA therapy, costs associated with therapy, underinsured status, longer time needed for screening HIV/HCV and time required for counseling. [5,47] Achieving SVR12 has also been shown to affect quality of life (QoL) in patients with HIV/HCV coinfection. Prior to DAA therapy availability, QoL reported by patients with HIV/HCV coinfection was significantly lower than in HIV mono-infected patients.…”

Section: Discussionmentioning

confidence: 99%

“…[4] Nearly 75% to 82% of PLWH who inject drugs are also infected with HCV. [2,4,5] Prior to potent combination antiretroviral therapy (ART), early studies suggested that progression to fibrosis is accelerated in patients with HIV/HCV coinfection. Factors affecting disease progression in this population include increased alcohol use, older age, longer duration of HCV infection, and immunosuppression (CD4 < 200 cells/mm 3 ).…”

Section: Introductionmentioning

confidence: 99%

“…[13][14][15][16][17] In the past, persons with HIV/HCV coinfection achieved lower rates of sustained virologic response (SVR) after use of interferon and ribavirin HCV treatment compared with those with HCV mono-infection. [5] In addition to poor efficacy, older HCV treatment regimens were associated with many adverse effects such as depression, anemia, flu-like symptoms, and were often contraindicated due to additional comorbidities within the PLWH. [18][19][20] With the development of interferon-free DAA therapies, the treatment platform for PLWH has been revolutionized and efficacy in patients with HIV/HCV coinfection has improved.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…The achievement of sustained virological response 12 weeks after completion of treatment (SVR12) has been associated with improved liver function, decreased clinical complications and all-cause mortality [7][8][9][10]. With regard to HIV coinfection, inferior treatment response in patients with HIV is no longer a concern and regimens proven efficacious in HCV monoinfection are widely applicable to patients with HIV [11]. However, little is known about whether HIV coinfection modifies outcomes of HCVrelated liver disease after achieving SVR.…”

Section: Introductionmentioning

confidence: 99%

Advanced liver disease outcomes after hepatitis C eradication by human immunodeficiency virus infection in PITER cohort

et al. 2020

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Background Liver disease progression after Hepatitis C Virus (HCV) eradication following direct-acting antiviral (DAA) treatment in the real-life setting according to Human Immunodeficiency Virus (HIV) coinfection was evaluated. Methods Patients consecutively enrolled in PITER between April 2014 and June 2019 and with at least 12-weeks follow-up following treatment were analysed. Cox regression analysis were used to evaluate HIV coinfection and factors independently associated with liver disease outcomes following viral eradication in DAA treated patients with pre-treatment liver cirrhosis. Results 93 HIV/HCV coinfected and 1109 HCV monoinfected patients were evaluated during a median follow-up of 26.7 (range 6-44.6) and 24.6 (range 6.8-47.3) months, respectively. No difference in the cumulative HCC incidence and hepatic decompensation was observed between coinfected and monoinfected patients. Age (Hazard Ratio [HR] = 1.08; 95% CI 1.04-1.13), male sex (HR = 2.76; 95% CI 1.28-5.96), lower albumin levels (HR = 3.94; 95% CI 1.81-8.58), genotype 3 (HR = 5.05; 95% CI 1.75-14.57) and serum anti-HBc positivity (HR = 1.99, 95% CI 1.01-3.95) were independently associated with HCC incidence. Older age (HR = 1.03; 95% CI 1.00-1.07), male sex (HR = 2.13; 95% CI 1.06-4.26) and lower albumin levels (HR = 3.75; 95% CI 1.89-7.46) were independently associated with the appearance of a decompensating event after viral eradication. Conclusion Different demographic, clinical and genotype distribution between HIV coinfected vs those monoinfected, was observed in a representative cohort of HCV infected patients in Italy. Once liver cirrhosis is established the disease progression is decreased, but still persists regardless of viral eradication in both coinfected and monoinfected patients. In patients with cirrhosis, HIV coinfection was not associated with a higher probability of liver complications, after viral eradication.

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“…It is important to note that despite the reduction of HIV infection among PWID almost all HIV positive PWID are still infected with HCV suggesting that decline of HCV infection among PWID can only been achieved by significant reduction of circulation of HCV in the community. It is hoped that this will happen after new DAAs for treatment of chronic HCV infection are made available to all patients including PWID and HIV/HCV co-infected patients (25,26). According to our study as of end of 2015 only 5% of patients with HCV were receiving anti-HCV treatment similar to other Eastern European countries (27,28).…”

Section: Discussionmentioning

confidence: 71%

Dynamics of hepatitis C epidemic among people living with HIV in Estonia

Kase¹,

Avi²,

Toompere³

et al. 2020

Preprint

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Background Estonia has a typical Eastern European HIV epidemic where the most frequent co-infection is chronic hepatitis C (HCV). We aimed to describe the changes in HCV prevalence, the distribution of HCV genotypes (GT), and HCV treatment in Estonian people living with HIV over 15 years. Methods We used data of subjects included to the Estonian HIV Cohort Study (E-HIV) before 31 st of December 2015. We compared two time periods – first, 1 st of January 2000 - 31 st of December 2008 when HIV epidemic was mostly spreading among people who inject drugs (PWID) and second, 1 st of January 2009 to 31 st of December 2015 when HIV started to emerge to general population. Results Of 4422 HIV positives 3708 (84%) had information about their HCV serostatus; 2706 (61%) were HCV seropositive, of latter 1625 (60%) were HCV RNA positive, 239 (9%) had their HCV GT determined, and 141 (5%) received treatment for HCV. HCV prevalence was 1.5 times (95% CI 1.4-1.6) higher in subjects diagnosed with HIV in first as compared to those diagnosed in second period (84% vs 56%, respectively). There were more men and the median age at HIV diagnosis was lower in HIV/HCV co-infected than in HIV mono-infected patients (70% vs 47% and 24 years vs. 30 years, respectively; both p<0.001).Conclusion There is a decrease in HCV prevalence but it remains high among HIV positive PWID, suggesting that there is need for improvement of harm reduction programs among PWID.

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Update in HIV–hepatitis C virus coinfection in the direct acting antiviral era

Cited by 23 publications

References 92 publications

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

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

Advanced liver disease outcomes after hepatitis C eradication by human immunodeficiency virus infection in PITER cohort

Dynamics of hepatitis C epidemic among people living with HIV in Estonia

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