Better Immune Outcomes in HIV/HCV Co-Infection With DAA Regimen

Patients co-infected with HIV and HCV may have better outcomes with direct-acting antiviral agents than patients with HCV mono-infection.

Patients co-infected with HIV and hepatitis C (HCV) may have better outcomes with direct-acting antiviral (DAA) agents compared with patients with HCV mono-infection, according to study findings published in Hepatology Communications

In patients with HIV/HCV co-infection, there is an associated accelerated rate of hepatic fibrosis progression and higher rates of liver decompensation and death compared with patients infected with HCV alone. However, it is unclear whether DAA combinations have differential effects on immunophenotypes and functions after successful HCV therapy in patients with co-infection. In this study, researchers assessed the peripheral T-cell immunophenotypes and functions in patients with both HIV and HCV infection who were successfully treated with combination DAA regimens.

Peripheral blood mononuclear cells were analyzed at baseline and at the time of sustained viral response were obtained from individuals who were enrolled in 2 prospective single-center phase 2 studies. Patients were treated with 3 different combination DAA regimens: daclatasvir and asunaprevir for 24 weeks (CONQUER 2-DAA), daclatasvir/asunaprevir/beclabuvir for 12 weeks (CONQUER 3-DAA), and sofosbuvir and ledipasvir for 12 weeks (ERADICATE study). Overall, the findings suggest that DAA combination therapy targeting 3 steps in the HCV replication cycle are more effective in improving T-cell immunophenotypes vs focus on only 2 viral targets.  There was also an improvement in T-cell activation phenotypes demonstrated by a subsequent decrease in CD38 expression and resolution of T-cell activation after treatment with CONQUER 2-DAA and 3-DAA therapies.

“Our findings require further confirmation in larger studies with comparable

baseline demographics,” wrote the researchers. “We hope that our results are hypothesis-generating and can be further confirmed in larger studies.”

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Shrivastava S, Bhatta M, Ward H, et al. Multitarget direct-acting antiviral therapy is associated with superior immunologic recovery in patients coinfected with human immunodeficiency virus and hepatitis C virus. Hepatol Commun. 2018;2(12):1451-1466.