Safety, Efficacy of DAAs for Hepatitis C Virus Genotype 6 Infection in People With HIV

HCV
Hepatitis C virus, computer illustration. Hepatitis C is an RNA (ribonucleic acid) virus from the Flaviviridae family. It is transmitted by blood, sexual intercourse, and across the placenta. It infects liver cells causing an inflammatory disease that can lead to degeneration and scarring (cirrhosis).
A team of researchers analyzed the virologic response of hepatitis C virus to direct-acting antivirals in patients with HIV.

Sustained virologic response was observed among people with HIV at 12 weeks off-therapy after receiving treatment with direct-acting antivirals (DAAs) for hepatitis C virus (HCV) genotype 6 (HCV-6) infection, according to study findings published in the World Journal of Gastroenterology.

In Taiwan, people with HIV are provided with combination antiretroviral therapy (ART) and health monitoring free-of-charge. In 2019, the HCV treatment program was expanded to provide people with HIV with testing and DAAs. Practicing physicians chose between glecaprevir/pibrentasvir (GLE/PIB), sofosbuvir/ledipasvir (SOF/LDV) +/- ribavirin, SOF/velpatasvir (SOF/VEL) +/- ribavirin, or SOF/daclatasvir (SOF/DCV) +/- ribavirin DAA regimens on the basis of liver status and preference.

In this multicenter, retrospective, observational study, people with HIV with HCV-6 coinfection (N=349) were evaluated for safety and efficacy 12 weeks after treatment conclusion. Efficacy was defined as HCV RNA lower than 30 IU/mL.

At baseline, the study population included 82.5% men, participants had a mean age of 48.9±11.7 years, 80.5% injected drugs, 96.0% had HIV viral loads lower than 50 copies/mL, 94.8% had CD4 counts 200 cells/mm3 or greater, and 10.9% had cirrhosis of the liver.

At DAA initiation, 39.3% were using non-tenofovir disoproxil fumarate (TDF)/tenofovir alafenamide (TAF)-based ART, 34.4% TDF-based ART, and 26.4% TAF-based ART.

The patients were prescribed GLE/PIB (51.9%), SOF/LDV (41.5%), SOF/VEL (6.3%), and SOF/DCV (0.3%) DAA regimens.

At week 12 off-therapy, 92.3% had sustained virologic response, 3.7% had no response, and 4.0% were lost to follow-up. Stratified by injection drug use, no significant difference in the rate of virologic response was observed (92.1% vs 92.9%; P =.999). Similarly, no significant differences in virologic responses were observed on the basis of DAA regimens (range, 91.2%-97.5%; all P >.05).

The people with HIV who received SOF/TDF were associated with significantly decreased estimated glomerular filtration rate (eGFR) during DAA therapy (P £.025), but eGFR improved after DAA discontinuation.

Plasma HIV RNA was maintained at lower than 50 copies/mL among 94.4%.

This study may have been limited by not having access to information about treatment adherence.

The study authors concluded that DAA treatment for HCV-6 was effective and safe among people with HIV.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please refer to the original reference for a full list of authors’ disclosures.

Reference

Sun H-Y, Cheng C-Y, Lin C-Y, et al. Real-world effectiveness of direct-acting antivirals in people living with human immunodeficiency virus and hepatitis C virus genotype 6 infections. World J Gastroenterol. 2022;28(11):1172-1183. doi:10.3748/wjg.v28.i11.1172

This article originally appeared on Gastroenterology Advisor