DAAs produce cure rates in HCV/HIV co-infection similar to monoinfection
Using direct-acting antiviral therapies demonstrated similarly high rates of sustained virologic response for hepatitis C virus infection in patients with and without HIV infection as compared with rates for HCV mono-infected patients, according to findings published in Hepatology.
“Because of low [sustained virologic response] rates associated with interferon-based therapies, the accelerated progression of HCV related liver disease, and barriers to receiving treatment, the [FDA] identified those infected with HIV and HCV co-infection as being a specific population with unmet medical needs,” Cameron Sikavi, third-year resident from the department of medicine at Harbor-University of California at Los Angeles Medical Center, and colleagues wrote. “With the advent of [DAA] therapies, HCV treatment has resulted in higher cure rates with short treatment duration in comparison to pegylated-interferon and ribavirin based therapies, in addition to improved safety and tolerability profiles.”
Prior research has shown that DAA treatment can improve life expectancy and SVR rates. Using clinical databases, researchers performed a systematic review of the treatment for chronic HCV infection in patients infected with HIV to determine whether using DAA agents addresses an unmet medical need in these patients and results in similar SVR rates as HCV mono-infected persons. In their review, the investigators included studies dated between January 2004 and July 2017, searching the keywords “hepatitis C,” “HIV,” “coinfection” and “direct-acting antiviral.”
Patients with HCV and HIV coinfection treated with interferon-based treatments had substantially lower SVR rates compared with rates seen in HCV mono-infected patients. Mono-infected persons who started taking DAA agents had similar SVR rates as compared with co-infected persons, with SVR greater than 93%. In comparison to interferon-based regimens, DAA medications have been shown to have improved the safety, efficacy and tolerability in both co-infected and mono-infected patients. Sikavi and colleagues also note that physicians should be aware of antiretroviral medications for HIV before starting a patient on HCV treatment, and of comorbidities that may impact SVR.
“Given the success of DAA therapy, it is imperative that future research be aimed at identifying programs and interventions that reduce the risk of reinfection among this population,” Sikavi and colleagues wrote. “Clinicians must remain vigilant, especially with regard to identifying drug-drug interactions, negative predictors or SVR, and barriers to care. By doing so, the improvements in SVR rates afforded with DAAs can address an unmet medical need among the coinfected population, with significant clinical implications.” – by Savannah Demko
Disclosure : The authors report no relevant financial disclosures.