Two recent studies have come to conflicting conclusions about whether HIV coinfection affects the chance of achieving a hepatitis C virus (HCV) cure through direct-acting antiviral (DAA) treatment in a real-world setting, aidsmap reports. Researchers presented these studies at the 51st International Liver Congress in Barcelona.
One study included 9,604 people with hep C who received treatment for the virus from the Veterans Health Administration before September 2015. A total of 408 (4.3 percent) of the participants were coinfected with HIV. Three quarters of them had genotype 1 of hep C, 48 percent had cirrhosis and 8 percent had previously been treated with Victrelis (boceprevir) or Incivek (telaprevir).
Approximately one in three of the participants were treated with Sovaldi (sofosbuvir) and Olysio (simeprevir), while 58 percent took Harvoni (ledipasvir/sofosbuvir) and 11 percent received Viekira Pak (ombitasvir/paritaprevir/ritonavir; dasabuvir).
Overall, 87 percent of those treated with Sovaldi and Olysio achieved a sustained virologic response 12 weeks after completing therapy (SVR12, considered a cure), while 93 percent of those who took Harvoni and 93 percent of those who received Viekira Pak were cured. Among those with HIV/HCV coinfection, the corresponding cure rates were 88 percent, 93 percent and 89 percent. The differences between the cure rates among those with and without HIV were not statistically significant, meaning they could have occurred by chance. This held true even after researchers controlled the data for individuals’ demographics, the severity of their liver disease and other health problems.
In the other study, researchers conducted a prospective analysis of 680 people with HCV monoinfection in the GEHEP-MONO cohort and 596 HIV/HCV–coinfected people in the HEPAVIR-DAA cohort who received DAA treatment from 33 sites in Spain after October 2011.
Most commonly, the collective cohort had genotypes 1a and 1b. Approximately 60 percent had been treated for hep C before and about that same proportion was cirrhotic.
Forty-three percent of the overall cohort received treatment with interferon and ribavirin plus Sovaldi, Olysio, Victrelis or Incivek. Fifty-seven percent were treated with Sovaldi plus Olysio, Harvoni, Sovaldi plus Daklinza (daclatasvir), Viekira Pak or Technivie (ombitasvir/paritaprevir/ritonavir); all these regimens were given with or without ribavirin.
Sixty-six percent of the HCV-monoinfected individuals were cured, as were 55 percent of the HIV/HCV–coinfected cohort members. This difference was statistically significant. Among those receiving interferon-free regimens, the respective cure rates were 95 percent and 89 percent, a statistically significant difference.
After controlling the data for age, sex, hep C genotype and HCV viral load before starting treatment, the researchers found that HIV/HCV coinfection was independently linked to a 41 percent reduced likelihood of a cure. Compared with receiving interferon-based treatment, undergoing interferon-free therapy was associated with a 7.93-fold greater likelihood of a cure. The researchers did not find that the length of treatment, ribavirin use, previous experience with HCV treatment or HCV viral load before treatment were associated with differences in the chance of a cure.
To read the aidsmap article, click here.