HIV/HCV Coinfection Safely Treated With DAAs

Direct-acting antiviral agent (DAA)-based therapy is safe and highly effective for the treatment of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfection, according to a new study.

From November 2014 to August 2016, the researchers evaluated 2369 patients with HIV/HCV coinfection, of whom 59.5% did not have cirrhosis, 33.9% had compensated cirrhosis, and 6.6% had decompensated cirrhosis.
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Patients were treated with regimens including sofosbuvir /ledipasvir (61.9%), sofosbuvir plus daclatasvir (14.6%), dasabuvir plus ombitasvir/paritaprevir/ritonavir (13.2%), and others (10.3%). The researchers noted that 30.6% of patients were treated with ribavarin.

Sustained virologic response (SVR) was assessed at 12 weeks post-treatment, and predictors of treatment failure were identified via multivariable logistic regression.

Results of an intention-to-treat analysis showed that SVR occurred in 92.0% of patients overall (93.8% of patients without cirrhosis, 91.0% of patients with compensated cirrhosis, and 80.8% of patients with decompensated cirrhosis). The researchers noted that very few patients (less than 1%) discontinued therapy due to adverse events.

In this cohort, factors such as male sex, (adjusted odds ratio [aOR] 1.75), an HCV RNA load of at least 800,000 IU/mL (aOR 1.63), compensated cirrhosis (aOR 1.35), and decompensated cirrhosis (aOR 2.92) were associated with treatment failure.

“In conclusion, in this large real-world study, DAA-based therapy was safe and highly effective in coinfected patients,” the researchers wrote. “Predictors of failure included gender, HIV-related immunosuppression, HCV RNA load, severity of liver disease, and the use of suboptimal DAA-based regimens.”

—Christina Vogt

Reference:

Berenguer J, Gil-Martin A, Jarrin I, et al. All-oral DAA therapy against HCV in HIV/HCV-coinfected subjects in real-world practice: Madrid CoRe findings [Published online January 29, 2018]. Hepatology. doi:10.1002/hep.29814.