An analysis of patients with HIV who were being treated for hepatitis C virus infection found that most were cured of HCV, and that the 7% who failed direct-acting antiviral therapy did so primarily because they did not complete it, due to patient-related factors like mental illness and ongoing illicit drug use, researchers reported.
“Real-world studies have confirmed the high efficacy and excellent tolerability of direct-acting antivirals (DAA) for the treatment of HCV infection in people living with HIV (PLWH). Overall, more than 90% of PLWH treated with DAA achieve cure. Hence, the World Health Organization proposed goals to eliminate HCV by 2030, and the British HIV Association considered that HCV could be eliminated in PLWH in the United Kingdom by 2021,” Edward R. Cachay, MD, professor of clinical medicine at the University of California, San Diego, and colleagues wrote in Open Forum Infectious Diseases.
“To achieve this goal, we need to decrease the proportion of PLWH with ongoing HCV viremia through HCV screening, linkage, treatment uptake and implementation of harm reduction strategies to prevent HCV re-infection. The causes of HCV treatment failure and resulting ongoing HCV viremia are different depending on whether there is virologic failure or premature treatment discontinuation.”
Cachay and colleagues investigated the predictors of HCV treatment failure in a retrospective cohort analysis of PLWH treated at several sites in Spain, Italy and the United States. During the study, they also collected data on ongoing illicit drug use, alcohol abuse, mental illness and unstable housing.
According to the study, among 784 PLWH who were treated with DAAs between January 2014 and December 2017, 93% were cured. Of the group that failed therapy, 50.9% discontinued therapy, died or were lost to follow-up (clinical failure), 47.3% experienced HCV virologic failure and one patient was reinfected with HCV.
Ongoing drug use (OR = 2.60) and mental illness (OR, 2.85) were independent predictors of HCV treatment failure, and the presence of both explained 20% of the risk for HCV treatment failure (OR = 7.47; P < .0001), Cachay and colleagues wrote. Additionally, they concluded that ongoing illicit drug use (OR = 2.75) and advanced liver fibrosis (OR = 2.29) were predictors of HCV virologic failure.
“In conclusion, we found that PLWH with complex barriers to care can be treated successfully with DAA,” the authors wrote. “PLWH with ongoing illicit drug use and mental illness, in particular, and those with advanced liver fibrosis might benefit from enhanced DAA treatment support to prevent the risk of HCV treatment failure.” – by Caitlyn Stulpin
Disclosures: Cachay reports receiving research funding from Merck and Gilead Sciences and lecture honoraria from Gilead. Please see the study for all other authors’ relevant financial disclosures.