Well tolerability and highly effective treatment response for hepatitis C virus-human immunodeficiency virus–coinfected patients treated by all-oral direct-acting antivirals

Abstract

Background: Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) coinfection is common because the two pathogens share their transmission route. Studies have suggested that coinfection is associated with accelerated hepatic fibrosis, increased hepatic decompensation, and hepatocellular carcinoma development. Historically, the sustained virological response (SVR) rates for patients undergoing pegylated interferon (PEG-IFN)-based therapy are poor owing to advanced liver disease, immune dysfunction, and poor medical adherence. This study aimed to investigate the efficacy and safety of oral direct-acting antivirals (DAAs) in HCV-HIV-coinfected patients. Methods: Between January 2017 and February 2020, 52 consecutive HCV-HIV-coinfected patients treated with oral DAAs (paritaprevir/ritonavir, ombitasvir, and dasabuvir: 7; daclatasvir and asunaprevir: 1; glecaprevir and pibrentasvir: 15; and sofosbuvirbased drugs: 29) were enrolled. The DAA regimen was selected based on the genotype/subtypes, patient characteristics, potential drug-drug interaction profiles, and health insurance reimbursement criteria. SVR 12 was defined as undetectable HCV RNA (<15 IU/ mL) at the end of therapy and 12 weeks after therapy completion. Results: The mean age of the enrolled patients was 42 ± 10.2 years; 92.3% of the patients were male and 32.7% had advanced fibrosis or cirrhosis. Nine (17.3%) patients had failed previous IFN therapy. The genotype distribution was as follows: 1a: 8; 1b: 23; 2: 14; 3: 1; and 6: 6. The baseline HCV RNA level before DAA administration was 6.56 ± 0.9 log 10 IU/mL, and 67.3% of patients had baseline HCV RNA >2 000 000 IU/mL. After posttreatment follow-up, all 52 patients (100%) achieved SVR 12 . Subjective and laboratory adverse events during therapy were generally mild, and none of the patients terminated therapy early. Conclusion: A highly effective treatment response and good tolerability were achieved using the oral DAAs for the HCV-HIVcoinfected patient population, which has been considered difficult to treat using IFN-based therapy in the past with urgent unmet medical needs.

Sofosbuvir-based antiviral therapy provided highly treatment efficacy, safety, and good tolerability for Taiwanese chronic hepatitis C patients with decompensated cirrhosis

“…The SVR 12 rate was 97.6% in CTP class B population and 88.9% in CTP class C population, respectively. Similar to our previously published reports, 24,25 an equivalent or even better treatment response was observed in Taiwanese CHC patients when compared with real-world data from other geographic regions. 26–32 After successful antiviral therapy, a significant improvement in hepatic functional reserve could be achieved.…”

Factors associated with high alanine aminotransferase (ALT) and cirrhosis in people living with HIV on combination antiretroviral treatment (cART) in the Asia‐Pacific

“…Furthermore, patients on treatment for HCV have shown a rapid normalization of ALT levels preventing progression to cirrhosis and HCC. 30 The studies done in settings with limited access to HCV RNA testing have discussed considering PLHIV with HCV-antibody positive test as chronically infected until further testing confirms otherwise. 31 There are a few limitations in this study.…”

“…Studies on HCV co‐infection have identified high HCV RNA levels (>800 000 IU/ml) at baseline among those with fluctuating ALT levels who have later developed liver disease. Furthermore, patients on treatment for HCV have shown a rapid normalization of ALT levels preventing progression to cirrhosis and HCC 30 . The studies done in settings with limited access to HCV RNA testing have discussed considering PLHIV with HCV‐antibody positive test as chronically infected until further testing confirms otherwise 31 …”

Residual risk of hepatocellular carcinoma development for chronic hepatitis C patients treated by all oral direct-acting antivirals with sustained virological response

“…Serum quantitative HCV RNA levels were measured prior to initiating DAA treatment, at week 4 (optional), at the end of treatment, and at post-treatment week 12 to determine the virological response. 19,20 SVR 12 was defined as an undetectable HCV RNA level on real-time polymerase chain reaction (PCR) (≤15 IU/mL) after DAA treatment and 12 weeks after completing therapy. Patients without SVR 12 data were considered to have not achieved SVR 12 .…”