Hepatitis C virus treatment should be a high priority among individuals with HIV coinfection, according to data published in Clinical Infectious Diseases. Treatment should be initiated with a multi-disciplinary approach including pharmacists, HIV treatment experts, and liver disease specialists to achieve optimal patient outcomes.
Developments in antiretroviral therapy (ART) have improved the life expectancy of patients with HIV, which has resulted in renewed attention to non-HIV-related diseases that can be affected by HIV infection. David L. Wyles, MD, of the Divisions of Infectious Diseases at the University of Southern California in San Diego, and colleagues evaluated the epidemiology of hepatitis C infection and the efficacy of emerging treatments in individuals with an HIV and hepatitis C coinfection.
The researchers pointed out that the results from recent studies using all-oral hepatitis C regimens have shown high SVR12 rates of sustained virologic response in both clinical trials and real-world settings. The ALLY-2 trial, which assessed the safety and efficacy of daclatasvir and sofosbuvir combination treatment, found that high SVR12 rates were achieved after a 12-week treatment. Patients with hepatitis C genotype 1 who were previously untreated had an SVR12 rate of 96.4%, while treatment-experienced patients had an SVR12 rate of 97.7%.
The TURQUOISE I trial has also shown that after a 12-week, all-oral regimen combining ombitasvir, paritaprevir, and dasabuvir, 94% of coinfected patients achieved the SVR12 response rate. The rate was 91% for patients in the 24-week group receiving the same regimen.
In the PHOTON-2 trial, which tested the safety and efficacy of sofosbuvir and ribavirin, the researchers found that the SVR12 rate was 85% in treatment-experienced patients with hepatitis C genotype 1, 88% for genotype 2, 89% for genotype 3, and 84% for genotype 4.
The researchers concluded that individuals with HIV and hepatitis C coinfection can achieve hepatitis C cure at the same rate as those without HIV.
Dr Wyles and his colleagues also point out that while high rates of hepatitis C cure are encouraging in coinfected individuals, hepatitis C reinfection is a concern that requires additional investigation. A recent meta-analysis presented at CROI 2015 found that the risk of hepatitis C reinfection was varied based on a patient’s risk and HIV serostatus. Prior studies have also indicated that reinfection rates are higher in HIV-infected individuals with high-risk behavior.=
“It is incumbent on practitioners to carefully review a patient’s HIV treatment history before switching therapies to accommodate HCV treatment,” the authors wrote. “Last, practitioners should understand the risks for HCV reinfection and inform patients of measures they can take to protect themselves and others,” the authors of the study wrote.
Wyles DL, Sulkowski MS, Dieterich D. Management of hepatitis C/HIV coinfection in the era of highly effective hepatitis C virus direct-acting antiviral therapy. Clin Infect Dis. 2016;63(1):3-11. doi: 10.1093/cid/ciw219.