Year 2018 / Volume 110 / Number 1
Original
Effectiveness of direct-acting antiviral therapy in patients with a HCV/HIV coinfection. A multicenter cohort study

35-43

DOI: 10.17235/reed.2017.5210/2017

David Rial-Crestelo, Miguel Rodríguez-Cola, Francisco Javier González-Gasca, Paloma Geijo-Martínez, Olga Belinchón-Moya, Elisa Martínez-Alfaro, Fernando Mateos-Rodríguez, José Ramón Barberá, Miguel Yzusqui, Sonia Casallo, María García, Alfredo Espinosa-Gimeno, Miguel Torralba,

Abstract
Introduction: The effectiveness of direct-acting antiviral (DAA) agents has been demonstrated in clinical trials both in patients with mono and coinfections. The goal of the study was to analyze the effectiveness and toxicity of this therapy in real-life patients with a HIV/HCV coinfection and to identify variables that are associated with an unfavorable outcome. Methods: This was a multicenter ambispective study in a cohort of coinfected patients. Data were collected from eight centers in Castilla-La Mancha from 2014 to 2016. An intent-to-treat analysis was performed and any loss to follow-up, treatment withdrawal or toxicity was considered as a failure. Results: A total of 229 patients were included with a median age of 49.6 years and the majority were male (83%). Fewer than 10% had a detectable HIV-related viral load (VL). The most prevalent HCV genotype was 1 (65.1%). Fifty percent had cirrhotic liver disease and 65% had over 800,000 copies/ml of HCV VL. The global sustained viral response (SVR) was reached by 91.7% of cases. The most commonly used DAA regimen was sofosbuvir/ledipasvir. Ribavirin was included in 52% of regimens, 65.9% of cases completed 12-week regimens and 30% completed 24-week schemes. There were 19 therapy failures. No differences were observed between the various DAA strategies used. No independent predictor was found for SVR. Conclusions: HCV treatment in coinfected patients is highly successful in terms of SVR rate in the real-life setting and toxicity is exceptional. We identified no specific predictors of an unfavorable outcome.
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References
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1. Taylor LE, Swan T, Mayer KH. HIV coinfection with hepatitis C virus: evolving epidemiology and treatment paradigms. Clin Infect Dis. 2012 Jul;55 Suppl 1:S33-42.
2. Kohli A, Shaffer A, Sherman A, Kottilil S. Treatment of hepatitis C: a systematic review. JAMA. 2014 Aug;312(6):631–40.
3. Perez Cachafeiro S, Del Amo J, Iribarren JA, Salavert Lleti M, Gutierrez F, Moreno A, et al. Decrease in serial prevalence of coinfection with hepatitis C virus among HIV-infected patients in Spain, 1997-2006. Clin Infect Dis. 2009 May;48(10):1467–70.
4. Graham CS, Baden LR, Yu E, Mrus JM, Carnie J, Heeren T, et al. Influence of human immunodeficiency virus infection on the course of hepatitis C virus infection: a meta-analysis. Clin Infect Dis. 2001 Aug;33(4):562–9.
5. Berenguer J, Rodriguez-Castellano E, Carrero A, Von Wichmann MA, Montero M, Galindo MJ, et al. Eradication of HCV and non-liver-related non-AIDS-related events in HIV/HCV coinfection. Hepatology. 2017 Jan;
6. Barreiro P, Labarga P, Martin-Carbonero L, Amor A, Ruiz-Sancho A, Castellares C, et al. Sustained virological response following HCV therapy is associated with non-progression of liver fibrosis in HCV/HIV-coinfected patients. Vol. 11, Antiviral therapy. England; 2006.
7. Hadigan C, Kottilil S. Hepatitis C virus infection and coinfection with human immunodeficiency virus: challenges and advancements in management. Vol. 306, JAMA. United States; 2011 Jul.
8. Kim AI, Dorn A, Bouajram R, Saab S. The treatment of chronic hepatitis C in HIV-infected patients: a meta-analysis. Vol. 8, HIV medicine. England; 2007 Jul.
9. Milazzo L, Lai A, Calvi E, Ronzi P, Micheli V, Binda F, et al. Direct-acting antivirals in hepatitis C virus (HCV)-infected and HCV/HIV-coinfected patients: real-life safety and efficacy. HIV Med. 2017 Apr;18(4):284–91.
10. Menard A, Colson P, Catherine D, Isabelle R, Christelle T, Meddeb L, et al. First Real Life Evidence of New Direct-acting Antivirals (DAA) in Co-infected HIV HCV Patients: Better than Ever. Vol. 62, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. United States; 2016. p. 947–9.
11. Kwo P, Gane EJ, Peng C-Y, Pearlman B, Vierling JM, Serfaty L, et al. Effectiveness of Elbasvir and Grazoprevir Combination, With or Without Ribavirin, for Treatment-Experienced Patients With Chronic Hepatitis C Infection. Gastroenterology. 2017 Jan;152(1):164–175.e4.
12. Laufer NL, Rockstroh JK. Faldaprevir (BI 201335) for the treatment of hepatitis C in patients co-infected with HIV. Vol. 12, Expert review of anti-infective therapy. England; 2014 Feb.
13. Wyles DL, Ruane PJ, Sulkowski MS, Dieterich D, Luetkemeyer A, Morgan TR, et al. Daclatasvir plus Sofosbuvir for HCV in Patients Coinfected with HIV-1. Vol. 373, The New England journal of medicine. United States; 2015 Aug.
14. Naggie S, Cooper C, Saag M, Workowski K, Ruane P, Towner WJ, et al. Ledipasvir and Sofosbuvir for HCV in Patients Coinfected with HIV-1. Vol. 373, The New England journal of medicine. United States; 2015 Aug.
15. Montoya-Ferrer A, Fierer DS, Alvarez-Alvarez B, de Gorgolas M, Fernandez-Guerrero ML. Acute hepatitis C outbreak among HIV-infected men, Madrid, Spain. Vol. 17, Emerging infectious diseases. United States; 2011. p. 1560–2.
16. Berenguer J, Rivero A, Jarrin I, Nunez MJ, Vivancos MJ, Crespo M, et al. Human Immunodeficiency Virus/Hepatitis C Virus Coinfection in Spain: Prevalence and Patient Characteristics. Open forum Infect Dis. 2016 Mar;3(2):ofw059.
17. Esteban JI, Sauleda S, Quer J. The changing epidemiology of hepatitis C virus infection in Europe. J Hepatol. 2008 Jan;48(1):148–62.
18. Tapper EB, Bacon BR, Curry MP, Dieterich DT, Flamm SL, Guest LE, et al. Real-world effectiveness for 12 weeks of ledipasvir-sofosbuvir for genotype 1 hepatitis C: the Trio Health study. J Viral Hepat. 2017 Jan;24(1):22–7.
19. Sulkowski MS, Vargas HE, Di Bisceglie AM, Kuo A, Reddy KR, Lim JK, et al. Effectiveness of Simeprevir Plus Sofosbuvir, With or Without Ribavirin, in Real-World Patients With HCV Genotype 1 Infection. Gastroenterology. 2016 Feb;150(2):419–29.
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Rial-Crestelo D, Rodríguez-Cola M, González-Gasca F, Geijo-Martínez P, Belinchón-Moya O, Martínez-Alfaro E, et all. Effectiveness of direct-acting antiviral therapy in patients with a HCV/HIV coinfection. A multicenter cohort study. 5210/2017


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Publication history

Received: 01/08/2017

Accepted: 25/10/2017

Online First: 22/12/2017

Published: 12/01/2018

Article revision time: 62 days

Article Online First time: 143 days

Article editing time: 164 days


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