In patients with HIV/hepatitis C virus (HCV)-coinfection who receive oral direct-acting antiviral agents (DAAs) severe infections are relatively common, according to study results published in the Journal of Viral Hepatology.

The study included participants with HIV/HCV coinfection who had received all-oral DAA combinations (n=848). The researchers performed a retrospective review of clinical events reported between the start of DAAs and 12 months after sustained virologic response at 12 weeks.

Overall, 4.5% (n=38) of participants reported infections, representing an incidence of 4.6 infections per 100 person-years. From baseline, the median time to infection was 23 weeks. Of participants with infections, 13% (n=5) died; 4 had cirrhosis. In participants with infections, the frequency of previous AIDS was 54% (n=21) compared with 40% (n=324) in participants without infections (P =.084). The median nadir CD4 cell count in participants with infections was 75 cells/μL compared with 144 cells/μL in participants without infections (P =.047).

The researchers observed immunodepression-associated infections in 1.1% (n=9) of participants, all of whom had suppressed HIV replication during antiretroviral therapy.

“Remarkably, the reactivation of immunodepression-related infections in the setting of treatment with all-oral DAA regimens occur among patients with otherwise controlled HIV infection,” the researchers wrote.

These results indicate the need for clinicians to consider patients’ risk for immunodepression-related reactivations of latent infections.

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Several study authors have disclosed potential financial conflicts of interest. Please refer to original research for fill list of authors’ disclosures.

Reference

Macias J, Rivero-Juarez A. Early emergence of opportunistic infections after starting direct acting antiviral drugs in HIV/HCV coinfected patients [published online September 10, 2018]. J Viral Hepat. doi:10.1111/jvh.13003