Higher Virologic Response to DAAs in HCV, HBV Coinfection vs Monoinfection

Direct-acting antiviral (DAA) agents for treatment of hepatitis C virus (HCV) may have higher sustained virologic responses in people coinfected with HCV and hepatitis B virus (HBV), according to a results of a study presented at IDWeek 2019, held October 2 to October 6 in Washington, DC.

HCV infection affects millions of people worldwide and is a major public health problem. HCV treatment aims to eradicate the virus and prevent cirrhosis development. A treatment’s success is defined in terms of sustained virologic responses, which is defined as the undetectable levels of viral RNA in the blood after 24 weeks of therapy completion. DAA agents are a class of medications that target specific steps in the HCV viral life cycle and aim to shorten therapy length and improve sustained virologic response rate. However, there is a lack of data that explores DAA virologic response in people coinfected with chronic HBV and HCV. Further, the response of HCV treatment in those that have spontaneously cleared an HBV infection is unknown. Therefore, this study aimed to characterize DAA virologic response in people coinfected with HBV and HCV and those with spontaneously resolved HBV.

The Electronically Retrieved Cohort of HCV Infected Veterans (ERCHIVES) database is a large, well-established national cohort of veterans with and without HCV infection, has been used to identify all people with HCV who have been with a DAA regimen. Once identified, participants were categorized into 1 of 3 categories: HBV/HCV-coinfected (hepatitis B surface antigen [HBsAG]-positive, HBV DNA-positive, or positive for both); HCV-monoinfected; and resolved HBV (isolated hepatitis B core antibody). In total, 115 patients with HCV/HBV coinfection, 38,570 with HCV-monoinfection, and 13,096 who had resolved HBV infection were included. The rates of sustained virologic response were determined and compared for all groups. To determine factors associated with sustained virologic responses, a logistic regression model was used.

With the newer DAA regimens, results suggested that individuals who are coinfected may have higher sustained virologic response rates. Of the study cohort, 31.6% of those with HCV/HBV coinfection, 26.4% with resolved HBV, and 24.6% with HCV-monoinfection had cirrhosis at baseline. A statistically significant difference in sustained virologic response was seen between the HCV/HBV-coinfected group (90.4%) and the HCV-monoinfected group (83.4%) (P =.04); 84.5% of patients with resolved HBV achieved sustained virologic response.

Similarly, a logistic regression model suggested that sustained virologic response achievement was more likely in those with HCV/HBV compared with those who were monoinfected with HCV (odds ratio [OR] 2.25). Although not statistically significant, a trend towards an inversely proportional correlation of decreasing sustained virologic response rates and  increasing severity of liver fibrosis was seen in patients with HCV/HBV coinfection people (as determined by FIB-4 scores). In addition, factors that were found to be associated with a lower likelihood of sustained virologic response achievement included diabetes (OR 0.93), higher pre-treatment HCV RNA (OR 0.86), and cirrhosis at baseline (OR 0.85).

Overall, researchers concluded that, “HBV/HCV-coinfected persons have a higher overall SVR rates with newer DAA regimens.”

Reference

Butt AA, Yan P, Aslam Set al. Hepatitis C virologic response in hepatitis B and C coinfected persons treated with direct acting antiviral agents: results from ERCHIVES. Presented at: IDWeek 2019; October 2-6, 2019; Washington, DC. Poster 294