High rates of hepatitis C virus (HCV) cure using direct-acting antivirals in HIV/HCV-coinfected patients: a real-world perspective

Abstract

Objectives: There are few data on the real-world experience of FDA-approved oral hepatitis C virus (HCV) direct-acting antiviral (DAA) drug combinations in HIV/HCV-coinfected patients. We evaluated the safety and efficacy of DAA therapies in a cohort of HIV/HCV patients in a large urban clinic in Chicago.

Methods: HIV/HCV-coinfected adults (≥18 years) enrolled in the Northwestern University Viral Hepatitis Registry between January 2013 and June 2015 were analysed. Treated patients received one of the following DAA combinations: sofosbuvir/ledipasvir, sofosbuvir/ribavirin, sofosbuvir/simeprevir or paritaprevir/ritonavir/ombitasvir/dasabuvir ± ribavirin. The primary outcome was sustained virological response at 12 weeks after DAA completion (SVR12).

Results: Seventy-seven HIV/HCV patients were evaluated for DAA therapy. Most patients were male (62/77, 81%) and infected with HCV genotype 1 (67/77, 87%). Some 32/77 (42%) were cirrhotic and 29/77 (38%) had received prior treatment with an IFN-containing regimen. DAA therapy was more likely to be started in Caucasians than persons of other ethnicities (P = 0.01). The overall SVR12 rate was 92% in 52 patients who completed therapy and had follow-up by the end of the study: sofosbuvir/simeprevir, 32/33 (97%); sofosbuvir/ribavirin, 4/7 (57%); sofosbuvir/ledipasvir, 11/11 (100%); and paritaprevir/ritonavir/ombitasvir/dasabuvir, 1/1 (100%). Four patients relapsed after therapy with sofosbuvir/simeprevir (n = 1) or sofosbuvir/ribavirin (n = 3). Adverse events were uncommon and did not result in DAA treatment interruption or discontinuation.

Conclusions: The HCV DAA combinations of sofosbuvir/ledipasvir and sofosbuvir/simeprevir were highly effective and well tolerated in this diverse population of HIV/HCV-coinfected patients, many of whom had advanced liver disease. HIV coinfection should not be considered a barrier to successful HCV treatment with DAAs.

Figure 1.

Virological treatment outcome by DAA regimen (N = 54). SOF/SMV, sofosbuvir/simeprevir; SOF/RBV, sofosbuvir/ribavirin; SOF/LDV, sofosbuvir/ledipasvir; PrOD, paritaprevir/ritonavir/ombitasvir/dasabuvir. ^Four relapses; one death (SOF/SMV); one with EOT then lost to follow-up (SOF/SMV). ¹Twelve weeks GT1a/1b (n = 34) and 24 weeks GT1b (n = 1). ²Twelve weeks GT2a (n = 1), 16 weeks GT2a/b (n = 3), 24 weeks GT1a (n = 2) and 24 weeks GT3 (n = 1). ³Eight weeks GT1a (n = 2), 12 weeks GT1a/1b (n = 8) and 24 weeks GT1a (n = 1). ⁴Twelve weeks GT1a (n = 1).