Background The development of new direct acting antivirals (DAAs) for hepatitis C virus (HCV) represents an evolution in the treatment. As HIV-HCV coinfection is common, evaluation of DAAs’ effectiveness and drug interactions with antiretroviral therapy (ART) is useful in this population.
Purpose To assess the effectiveness of DAAs and drug interactions with ART in HIV/HCV-coinfected patients.
Material and methods Retrospective observational study, including HIV/HCV-coinfected patients who started DAAs (August 2015 to August 2017).
Data were obtained from outpatient software, electronic health records or interview with patients.
Effectiveness was assessed by achievement of virological response (week 4 of treatment, end of treatment and post-treatment week 12).
Interactions between DAAs and ART were evaluated by using the University of Liverpool Drug Interaction database.
Results Sixty-six HIV/HCV-coinfected patients (21.2% females), mean age 50.1 years (40–57; SD 3.9). HCV genotype distribution: 1a (40.9%), 4 (22.7%), 3 (18.2%), 1b (16.7%) and 2 (1.5%). 37.9% had cirrhosis and 15.2% were pretreated HCV patients. Median baseline HCV viral load was 1,942,570 IU/mL.
DAA regimens were mostly sofosbuvir/ledipasvir (63.6%), daclatasvir +sofosbuvir (19.7%) and ombitasvir/paritaprevir/ritonavir+dasabuvir (10.6%). Length of HCV treatment was 12 weeks in 89.4%.
Before starting DAAs, patients were receiving ART, being triple-drug in 66.7%. Most common ART was: NRTI/NtRTI+NRTI/NtRTI+boosted PI (30.3%), NRTI/NtRTI+NRTI/NtRTI+NNRTI (13.6%), NRTI/NtRTI+NRTI/NtRTI+integrase inhibitor (12.1%), boosted PI (10.6%) and NRTI/NtRTI+boosted PI (9.1%).
Thirty-nine potential interactions and five contraindications between DAAs and ART were identified, mostly only required monitoring. In 12 cases, the prescription of DAAs supposed a modification in ART and in one case a dose adjustment for the DAA.
At the analysis date, 58 patients had finished treatment, three were still receiving DAAs and five had discontinued it. 63.6% had a rapid virological response (undetectable serum HCV RNA level at week 4 of treatment). Regarding patients who completed DAA regimens, 92.1% had undetectable viral load at the end of treatment. Of 54 patients who had reached post-treatment week 12, 50 had sustained virological response, two presented detectable viral load (resistance mutations were found) and two had missed data.
Conclusion DAAs have shown a high effectiveness in HIV/HCV co-infected patients. In this population, an appropriate revision and management of drug interactions with ART is essential.
No conflict of interest
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