With DAAs, cure rates similar in HCV/HIV coinfection, monoinfection
Treatment with direct-acting antiviral therapies, or DAAs, demonstrated similarly high rates of SVR for hepatitis C virus infection in patients with and without HIV coinfection, according to findings from a systematic review published in Hepatology.
“Because of low SVR 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,” Sammy Saab, MD, MPH, AGAF, FAASLD, professor of medicine and surgery in the division of digestive diseases and head of outcomes research in hepatology at David Geffen School of Medicine, University of California, Los Angeles, and colleagues wrote. “With the improvements in life expectancy afforded with treatment, in conjunction with superior SVR rates with DAA therapy, re-evaluation of whether coinfected individuals should be considered a special population among those infected with hepatitis C is warranted.”
Using clinical databases, researchers performed a systematic review of the treatment of chronic HCV infection in patients coinfected with HIV to determine whether using DAA agents addresses an unmet medical need and results in similar SVR rates as those seen among HCV-monoinfected patients. In their review, the investigators included studies dated between January 2004 and July 2017.
Patients with HCV/HIV coinfection who were treated with interferon-based regimens had substantially lower SVR rates compared with HCV monoinfected patients. However, coinfected patients who received DAA agents had similar outcomes compared with monoinfected patients, with SVR rates exceeding 93%. Compared with interferon-based regimens, DAAs have been shown to have improved safety, efficacy and tolerability in both coinfected and monoinfected patients, the researchers said.
Saab and colleagues said the designation a “special population” applied to coinfected patients should be reconsidered. They also noted that physicians should be aware of 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,” Saab 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
- Sikavi C, et al. Hepatology. 2017doi:10.1002/hep.29642.
Disclosures: The authors report no relevant financial disclosures.