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. 2022 Sep 30;9(10):ofac508.
doi: 10.1093/ofid/ofac508. eCollection 2022 Oct.

Low Risk of Failing Direct-Acting Antivirals in People With Human Immunodeficiency Virus/Hepatitis C Virus From Sub-Saharan Africa or Southeastern Asia: A European Cross-Sectional Study

Cas Isfordink  1   2 , Anders Boyd  3   4 , Amanda Mocroft  5   6 , Katharina Kusejko  7   8 , Colette Smit  3 , Stephane de Wit  9 , Tabitha Mahungu  10 , Karolin Falconer  11 , Gilles Wandeler  12 , Matthias Cavassini  13 , Marcel Stöckle  14 , Janke Schinkel  15 , Andri Rauch  12 , Lars Peters  6 , Marc van der Valk  1   3 ; for EuroSIDA, the Swiss HIV Cohort Study, and the ATHENA Observational Cohort
Affiliations

Low Risk of Failing Direct-Acting Antivirals in People With Human Immunodeficiency Virus/Hepatitis C Virus From Sub-Saharan Africa or Southeastern Asia: A European Cross-Sectional Study

Cas Isfordink et al. Open Forum Infect Dis. .

Abstract

Background: Several studies have reported suboptimal efficacy of direct-acting antivirals (DAAs) to treat hepatitis C virus (HCV) subtypes endemic to sub-Saharan Africa (SSA) and Southeastern Asia (SEA). The extent of this issue in individuals with human immunodeficiency virus (HIV)/HCV from SSA or SEA residing in Europe is unknown.

Methods: We retrospectively analyzed data from several prospective European cohorts of people living with HIV. We included individuals with HIV/HCV who originated from SSA or SEA, were treated with interferon-free DAAs, and had an available HCV RNA result ≥12 weeks after the end of treatment. The primary outcome was sustained virological response at least 12 weeks after the end of treatment (SVR12).

Results: Of the 3293 individuals with HIV/HCV treated with DAA and with available SVR12 data, 142 were from SSA (n = 64) and SEA (n = 78). SVR12 was achieved by 60 (94% [95% confidence interval {CI}, 86%-98%]) individuals from SSA and 76 (97% [95% CI, 92%-99%]) from SEA. The genotypes of the 6 individuals failing DAA treatment were 2, 3a, 3h, 4a, 4c, and 6j. For 2 of the 4 unsuccessfully treated individuals with available sequence data at treatment failure, NS5A resistance-associated substitutions were present (30R/93S in an individual with genotype 4c and 31M in an individual with genotype 6j).

Conclusions: SVR12 rates were high in individuals with HIV/HCV residing in Europe and originating from regions where intrinsically NS5A-resistant HCV strains are endemic. HCV elimination for this population in Europe is unlikely to be hampered by suboptimal DAA efficacy.

Keywords: coinfection; elimination; hepatitis C virus; human immunodeficiency virus.

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Conflict of interest statement

Potential conflicts of interest. C. I. has received research funding from Gilead, not related to this study. A. M. has received honoraria, travel support, and/or consultancy fees from ViiV, Gilead, and Eiland & Bonnin, all outside the submitted work. K. F. has received honoraria from GSK, AbbVie, and Gilead, all outside the submitted work. G. W. has received unrestricted research grants form Gilead Sciences and Roche Diagnostics, unrelated to this work, as well as honoraria from ViiV, MSD, and Gilead Sciences (paid to his institution). M. C.'s institution received a conference grant from Gilead as well as research grants from Gilead, MSD, and ViiV. M. S. has received grants for conference participation from Gilead and MSD (Merck). J. S.'s institution has received research support and consultancy fees from Gilead, and a speaker’s fee from Janssen Pharmaceuticals, independent from the submitted work. A. R. reports support to his institution for advisory boards and/or travel grants from MSD, Gilead Sciences, Pfizer, and AbbVie, and an investigator-initiated trial grant from Gilead Sciences. All remuneration went to his home institution and not to A. R. personally, and all remuneration was provided outside the submitted work. M. v. d. V. reports honoraria or research grants from AbbVie, Gilead, MSD, and ViiV Healthcare, all outside the submitted work. All other authors report no potential conflicts.

Figures

Figure 1.
Figure 1.
Flowchart. *Reason for hepatitis C virus (HCV) RNA sustained virological response at least 12 weeks after the end of treatment results being unavailable: awaiting SVR12 HCV RNA measurement (n = 2), HCV RNA missing (n = 2), discontinued cohort participation soon after HCV treatment (n = 1). Abbreviations: DAA, direct-acting antiviral; SEA, Southeastern Asia; SSA, sub-Saharan Africa; SVR, sustained virological response at least 12 weeks after the end of treatment.
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