Antiretroviral Switches in HIV/HCV: No Increased Risk for Virologic Failure

HIV treatment and virologic failure, and sustained viral response at 12 and 24 weeks were not different between individuals with HIV/hepatitis C co-infection who did or did not switch antiretroviral medication regimens before treatment with direct antiretroviral medication, according to study results presented at IDWeek 2019, held from October 2- October 6, in Washington, DC.

In HIV/hepatitis C virus co-infection, direct-acting antivirals (DAA) and antiretroviral medications pose treatment challenges, and the management of contraindicated treatment combinations varies from practice to practice. Because antiretroviral therapy regimen switches may increase the risk of HIV virologic failure and treatment failure and has been reported to increase DAA treatment failure risk, this retrospective cohort study was designed to assess how antiretroviral therapy regimen switches affect treatment outcomes in adult patients with stable HIV/hepatitis C co-infection (HIV RNA<50 for ≥6 months) who received DAA hepatitis C therapy. Data analyzed were obtained by using the Centers for AIDS Research Network of Integrated Clinical Systems.

Participants switching antiretroviral therapy regimen within 6 months before DAA treatment were defined as the antiretroviral therapy switch cohort, and those with no change in the same time period were defined as the no-switch cohort. The primary study outcome was HIV treatment failure (including HIV virologic failure, progression to AIDS, discontinuation/change of antiretroviral therapy regimen, or death).

Of the 256 total participants, 25% were in the switch cohort. The most common baseline regimen in this group was protease inhibitor-based, while the most common baseline regimen for the no-switch group was integrase strand transfer inhibitor-based. The HIV/hepatitis C transmission risk factors, hepatitis C genotype, and alanine aminotransferase/aspartate aminotransferase (ALT/AST) were similar between the switch and no-switch groups. The percentage of participants with HIV treatment and virologic failure were also similar between the 2 groups, as were the proportions achieving sustained viral response at week 12 and sustained viral response at week 24.

The investigators concluded, “HIV treatment and virologic failure, and [sustained viral response at week 12 or 24] were not different among patients who did or did not undergo a switch in their [antiretroviral therapy] regimen prior to DAA treatment. This suggests that switches in ARV regimen for DAA treatment of HCV do not negatively impact HIV or HCV outcomes among patients with HIV/HCV Coinfection.”

Reference

Mosquera DM, Wilder J, Ellis A, Naggie S. Risk of virologic failure with antiretroviral switches in HIV/HCV coinfections. Poster presented at: IDWeek 2019; October 2-6, 2019; Washington, DC. Abstract 301.