Background Treatment of HIV/HCV coinfected patients requires attention to the complex drug interactions that can occur between new direct acting antivirals (DAAs) and antiretroviral drugs (ARVs).
Purpose To assess the effectiveness of new DAAs in a HIV-HCV coinfected population, and tTo review ARVs switches to allow compatibility of DAAs.
Material and methods This was an observational retrospective study. HIV/HCV coinfected patients treated with ledipasvir/sofosbuvir (LDV/SOF), ritonavir boosted paritaprevir/ombitasvir, dasabuvir (3D) or daclatasvir+sofosbuvir (DCV+SOF) were included from 1 April 2015 to 30 June 2016. Effectiveness was measured as rate of sustained viral response at 12 weeks after the end of therapy (SVR12). Collected data: age, gender, genotype, grade of fibrosis (METAVIR score), presence of cirrhosis, HCV RNA baseline and HCV treatment history.
Results A total of 71 subjects were studied, 79% (n=56) were men. Median age was 50 years (34–64). HCV genotypes (GT): GT1a (n=35), GT1b (n=16), GT3 (n=12) and GT4 (n=8). DAAs: 53 patients were treated with LDV/SOF (±RBV), 10 with DCV+SOF (±RBV) and 8 with 3D (±RBV). Fibrosis stage was F3–F4 in 58 (82%) patients and 43 (66%) had cirrhosis. Ribavirin was used in combination with DAAs in 32% of subjects; 51% (n=36) were naive, 48% had been previously treated with interferon+RBV and 1 patient with triple therapy. Mean HCV RNA baseline was 2.505.210 UI/mL. Overall, 66 patients (93%) achieved SVR12: including rates of 90% (GT1), 100% (GT3) and 100% (GT4). 5 patients did not achieve SVR12: adverse event (n=1), death (n=2) and relapse (n=2). In 9 (13%) patients at least one antiretroviral drug was switched and in all cases to an integrase inhibitor based regimen. Some interactions were found: tenofovir (with ritonavir boosted or efavirenz containing regimen) when given LDV/SOF (n=5), ritonavir boosted protease inhibitors with 3D or DCV (n=3) and etravirine with DCV (n=1). In 1 patient, the daily dose of DCV was reduced to half (30 mg/day).
Conclusion Effectiveness outcomes in the clinical setting were similar to clinical trials. New DAAs require few changes in antiretroviral therapy. LDV/SOF may be used with most ARVs, but renal function monitoring is required with tenofovir. The inhibitors of integrase might be a therapeutic of choice for the HIV/HCV coinfected population.
No conflict of interest
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